Job Description

Will drive consistent, efficient processes and share best practices in a collaborative effort with providers and staff, designed to facilitate achievement of goals set for Hierarchical Condition Category (HCC) Ratio, HCC Covered Ratio, and HCC Percent Covered. The Clinical Coding Nurse will drive Risk Adjustment Data Validation (RADV) and Risk Adjustment improvement initiatives, develop recommendations for RADV and Risk Adjustment remediation plans and create tools and databases to capture relevant data to achieve business and market specific RADV and Risk Adjustment goals and initiatives. This position will work collaboratively with the Project Manager, each team and their leadership in a matrix relationship.  This position will provide direction and guidance to provider relations, quality improvement staff as well as cross functional team members within their respective role pertaining to RADV and Risk Adjustment.


  • Registered nurse (current WI license)

  • BSN preferred

  • Experience in a managed care organization preferred

  • Clinical Coding Certificate or must be obtained within one year of hire

  • 3 to 5 years of professional experience in a clinical function.

  • Demonstrated time management, project management, negotiation and multi-tasking skills.

  • Demonstrated effective writing skills with experience developing documents and reports.

  • Independent judgment, analytical ability, and systems thinking to work in complex systems.

  • Interpersonal and communication skills to interact effectively with interdisciplinary health team members and providers.

  • Proficiency with Microsoft Office applications, including Excel, Access and PowerPoint preferred.