Coder-Risk Adjustment at WellSense Health Plan

Full time @Tarauli posted 7 months ago

Job Description

Coder-Risk Adjustment

Finance / Accounting




It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Coding Validation Program Coder manages the day-to-day responsibilities of chart abstraction, vendor auditing and reporting in accordance with state and federal regulations. The coder will abstract from in-patient and out-patient medical records and record findings via electronic data base and or excel spread sheets. The coder ensures that all claims accurately reflect the appropriate diagnosis information as outlined in the member’s medial record. The coder will respond to interdepartmental and provider inquiries guaranteeing that all work is in compliance with internal and external protocols and compliance requirements.


  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
  • Ability to code government and state models. This includes code everything projects.
  • Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
  • Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
  • Ability to maintain a 95% accuracy rate on all coding projects.
  • Handle other related duties as required or assigned.
  • Coders assist with code abstraction and coding quality audits using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures.


  • Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.) The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended.
  • Strong organizational skills
  • Technical savvy with high level of competence in basic computer skills, Microsoft Outlook, Word, Excel and Outlook.
  • Strong written and verbal communication skills
  • Ability to work independently in a remote environment.
  • Private lockable office space to ensure security of Member PHI
  • Minimum of 5 years coding experience with at least 3 of those years in Risk Adjustment coding.
  • High School Diploma
  • Completion of an accredited medical coding program with current unencumbered credentials.

Required education:

  • High School Diploma
  • CPC/CRC Certification

Required experience:

  • Risk Adjustment coding: 3 years
  • Coding: 5 years

Supervision Received

  • General supervision is received weekly.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

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