Certified Risk Adjustment Coder

Job Summary

Working remotely in a full-time capacity, the Certified Risk Adjustment Coder will perform risk adjustment coding and quality assurance validation, including prospective medical record reviews and concurrent outpatient claim diagnosis coding, while ensuring compliance with Medicare guidelines and coding regulations.

Key responsibilities

• Conduct prospective medical record reviews to support underlying diagnoses for clinician review
• Validate accuracy of ICD-10-CM codes prior to claim submission and collaborate with healthcare providers for documentation clarification
• Stay updated on coding regulations and participate in coding education initiatives to promote accurate practices

Required qualifications

• High school diploma or GED equivalent
• Current active coding credential through AAPC or AHIMA, with preference for CRC designation
• Minimum of one year of experience in the medical field, preferably in an outpatient setting
• Proficiency in ICD-10-CM coding guidelines and knowledge of medical terminology and anatomy
• Familiarity with Medicare risk adjustment methodologies and HCC coding principles