Certified Risk Adjustment Consultant

Job Summary

To enhance risk adjustment operations, the full-time Certified Risk Adjustment Consultant will conduct thorough reviews and validations of Medicare, Medicaid, and Commercial HCCs through medical record audits, ensuring compliance with coding standards and guidelines while providing education to providers as necessary.

Key responsibilities

• Perform ongoing audits of medical records to ensure accuracy in diagnosis and CPT coding
• Evaluate medical records for compliance with CMS and DxCG regulations and summarize findings for leadership
• Provide education and feedback to physicians regarding Risk Adjustment Coding guidelines and ICD-10-CM standards

Required qualifications

• Certified Risk Adjustment Coder (CRC) or must obtain within the first 12 months of employment
• Two years of outpatient billing, coding, and risk adjustment experience
• Strong understanding of ICD-10-CM coding standards and CMS guidelines
• Experience with primary care adult medicine is preferred
• Associate's degree is preferred