Registered Nurse (RN) – HEDIS & Risk Adjustment

Join HealthSpective

Since 1997, HealthSpective has been a trusted healthcare management consulting firm dedicated to helping healthcare organizations improve quality, compliance, risk adjustment accuracy, and operational performance. As a nationally recognized healthcare consulting company, we partner with health plans, provider groups, and healthcare organizations to deliver expert audit support, data validation, and compliance solutions rooted in healthcare regulations and compliance best practices.

 

HealthSpective delivers end-to-end risk adjustment medical coding services to optimize RAF scores and improve clinical documentation. We are seeking a detail-oriented and experienced Risk Adjustment Medical Coder to join our growing remote team.

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Position Summary

​​The Registered Nurse (RN) will support quality improvement initiatives by conducting medical record reviews, HEDIS abstraction, risk adjustment validation, and clinical documentation review. The ideal candidate has strong knowledge of HEDIS measures and experience with risk adjustment programs.​

Key Responsibilities

• Perform HEDIS medical record abstraction and quality measure review

• Conduct clinical chart reviews to support risk adjustment and quality initiatives

• Identify documentation opportunities to improve coding accuracy and quality performance

• Collaborate with providers and internal teams to ensure accurate clinical documentation

• Participate in MRR (Medical Record Review) projects as assigned

• Maintain productivity and quality standards while meeting project deadlines

• Ensure compliance with HIPAA, CMS, NCQA, and company policies

Qualifications

Required

• Active, unrestricted Registered Nurse (RN) license

• Minimum of 2 years of clinical nursing experience

• Proven experience with HEDIS medical record abstraction and quality improvement initiatives
   

Preferred

• Experience with TRC and COA projects

• Certified Risk Adjustment Coder (CRC) credential

• Strong understanding of CMS Medicare Advantage, risk adjustment, and quality reporting programs

• Experience reviewing and interpreting clinical documentation and medical records

• Excellent analytical, organizational, and communication skills

• Proficiency with electronic health records (EHRs) and Microsoft Office applications

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What We Offer

• Fully remote work environment

• Competitive compensation

• Flexible scheduling opportunities

• Collaborative and mission-driven culture at a leading healthcare consultancy service

• Professional growth and development opportunities

• Opportunity to work with leading healthcare organizations nationwide​​​​​

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