Baystate Health

Registered Nurse – HCC/RAF Coding Specialist

Springfield, Massachusetts · Full-time

Sponsorship not specified$90k-$103kDetected 7 days ago

CernerICD-10CommunicationProblem SolvingCritical ThinkingMentoringMicrosoft Office

About the role

Registered Nurse - HCC/RAF Coding Specialist SUMMARY: The HCC/RAF Coding Nurse is responsible for conducting comprehensive medical record reviews and assigning accurate ICD-10-CM diagnosis codes for risk adjustment-eligible patients.
This position also serves as a clinical coding resource by providing education and guidance to providers while improving documentation quality, patient outcomes, and provider satisfaction.
Actual salaries may vary by position and will be determined based on the candidate's relevant experience.

Identify documentation gaps and collaborate with providers to clarify incomplete, conflicting, or ambiguous documentation.
Maintain accurate patient problem lists by adding, updating, and resolving diagnoses as appropriate.
Identify and validate chronic conditions that impact Medicare Risk Adjustment (RAF) and quality reporting.
Maintain compliance with organizational policies, CMS regulations, ICD-10-CM coding standards, and applicable federal and state laws.
Perform other duties as assigned.

Current Massachusetts Registered Nurse (RN) license required.
Minimum of three (3) years of clinical RN experience required.
Valid driver's license required.
Strong clinical knowledge of chronic disease management.
Knowledge of ICD-10-CM coding, CMS HCC guidelines, Medicare Risk Adjustment methodologies, HEDIS, and Clinical Documentation Improvement (CDI) principles.
Exceptional analytical and critical thinking skills with the ability to interpret complex clinical documentation and coding requirements.
Physician practice clinical experience may be considered.
Experience with HCC/RAF coding, Medicare Risk Adjustment, Clinical Documentation Improvement (CDI), or Population Health preferred.
Experience with electronic medical record systems
Strong presentation, facilitation, and provider education skills with the ability to effectively communicate complex coding and regulatory concepts to diverse clinical audiences.
Demonstrated ability to build collaborative relationships with providers and clinical staff through education, coaching, and consultation.

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system.
Typically, a new hire can expect a starting salary somewhere in the lower part of the range.
Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.
$89,606.00 - $103,001.00 - $121,804.00
Promote Medicare Annual Wellness Visits to support preventive care, documentation accuracy, and risk adjustment capture.

The HCC/RAF Coding Nurse is responsible for conducting comprehensive medical record reviews and assigning accurate ICD-10-CM diagnosis codes for risk adjustment-eligible patients.
The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system.

Baystate Health is an Equal Opportunity employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

This listing is sourced directly from Baystate Health's careers page and normalized into a canonical job model.