Certified Risk Adjustment Coder

Job Summary

A company is looking for an Individual & Family Plans (IFP) Quality Review and Audit Analyst.

Key Responsibilities

• Conduct medical records reviews and ensure accurate diagnosis code abstraction according to coding guidelines
• Utilize HHS' Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) from ICD-10-CM diagnosis codes
• Perform documentation and data audits to identify gaps and compliance risks in risk adjustment data

Required Qualifications

• High school diploma with at least 2 years of experience in medical coding certifications (CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC)
• Experience with medical documentation audits and proficiency in ICD-10-CM coding guidelines
• Familiarity with CMS regulations for Risk Adjustment programs
• Computer competency with Excel, MS Word, and Adobe Acrobat
• Understanding of medical claims submissions is preferred