Certified Risk Adjustment Coder

Job Summary

Evaluating complex medical conditions, the full-time Certified Risk Adjustment Coder will conduct medical records reviews, ensure compliance with coding guidelines, and identify trends for Continuous Quality Improvement while working remotely.

Key responsibilities

• Conduct medical records reviews and abstract diagnosis codes according to relevant guidelines
• Utilize HHS' Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)
• Perform documentation and data audits to identify gaps and compliance risks in risk adjustment data

Required qualifications

• High school diploma
• 2+ years' experience with relevant 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