Certified Risk Adjustment Coder

Job Summary

Working remotely on a temporary basis, a Certified Risk Adjustment Coder will perform risk adjustment coding reviews across Medicare, commercial, and Medicaid lines of business, ensuring accurate ICD-10-CM code assignment and maintaining a coding accuracy rate of 95%.

Key responsibilities

• Perform detailed reviews of risk adjustment coding for Medicare, Commercial, and Medicaid lines of business
• Analyze and audit medical records and encounter forms to verify ICD-10-CM and relevant code accuracy
• Provide weekly reports on coding audit results and trends to leadership using designated templates and communication channels

Required qualifications

• 2+ years of risk adjustment coding experience, preferably within a health plan environment
• 2+ years of experience with CMS HCCs and/or HHS-HCC models
• CRC certification
• Proficiency with Microsoft Office Suite including Outlook, Excel, Word, and Teams
• Experience with Medicaid CDPS model (preferred)