Posted on February 1, 2026

Revenue Cycle Specialist – HCC/Risk Adjustment Coding

Location: San Juan, PR Employment: Full-time Work setup: Compensation: $55,000 - $70,000

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Job Description

Optimize risk adjustment coding accuracy and revenue cycle performance for Alianza's growing value-based care payer contracts.

Responsibilities

  • Review and code clinical documentation for HCC (Hierarchical Condition Category) risk adjustment accuracy under Medicare Advantage and Medicaid managed care contracts
  • Conduct prospective and retrospective chart reviews to identify undercoded or unsupported diagnoses
  • Provide real-time coding feedback and education to physicians and clinical documentation teams
  • Process and submit claims for Alianza's primary care network with high clean-claim rates
  • Manage denial appeals and coordinate with payers on claims resolution
  • Monitor and report on coding accuracy metrics and revenue cycle KPIs
  • Stay current on CMS risk adjustment model updates and ICD-10-CM guideline changes

Requirements

  • CPC (Certified Professional Coder) or CRC (Certified Risk Adjustment Coder) certification required
  • 3+ years of coding experience; HCC/risk adjustment experience strongly preferred
  • Deep knowledge of ICD-10-CM, CPT, and HCPCS coding
  • Experience with Medicare Advantage and/or Medicaid managed care risk adjustment programs
  • Proficiency with EHR systems and coding/billing software
  • Bilingual English/Spanish preferred

Benefits

  • Competitive salary with performance incentives tied to coding accuracy metrics
  • Health, dental, and vision insurance
  • 401(k) with employer match
  • Paid time off and paid holidays
  • Continuing education and certification maintenance reimbursement
  • Hybrid work flexibility

The Critical Role of Risk Adjustment Coding

In value-based care, coding accuracy is not just a billing function—it is a clinical and financial imperative. Alianza Health Partners’ revenue cycle team sits at the intersection of clinical documentation and payer contracting, ensuring that the health status of our patient population is accurately captured in the risk scores that drive capitation and quality payments.

What You Will Do

As an HCC/Risk Adjustment Coding Specialist, you will be a key contributor to Alianza’s financial performance and quality outcomes. You will work closely with our clinical teams to ensure that the complexity of our patients’ health is fully and accurately documented, coded, and submitted—both prospectively in care management workflows and retrospectively in chart review programs.

The Opportunity

Puerto Rico’s managed care market is increasingly value-based, and accurate risk adjustment coding is one of the highest-leverage activities in the ecosystem. Alianza’s coding team operates at a sophisticated level, working with multiple payer contracts across Medicare Advantage, Medicaid, and commercial risk arrangements. You will build expertise across multiple risk adjustment models and become a recognized expert in a rapidly growing specialty.

Join Our Team

We offer a collaborative, professionally stimulating environment where your work is recognized, measured, and rewarded. Apply today at hello@alianza.health.