Licensed Clinical Risk Adjustment Specialist
Job Summary
To support coding accuracy and clinical documentation integrity, the fully remote Licensed Clinical Risk Adjustment Specialist will perform prospective reviews of medical records, validate chronic conditions, and ensure compliance with HCC coding standards.
Key Responsibilities
- Serve as a subject matter expert in clinical documentation quality, risk adjustment, and HCC coding integrity in outpatient settings
- Perform prospective reviews of medical records to validate chronic conditions and ensure documentation accuracy and appropriate coding
- Monitor and analyze CDI outcomes and documentation trends to identify improvement opportunities and support program goals
Required Qualifications
- Minimum 2 years of ambulatory Clinical Documentation Integrity, Risk Adjustment, or related healthcare documentation experience
- Active LPN or RN license required
- CCDS, CCDS-O, CDIP, CDEO, and/or CRC certification strongly preferred
- Proficiency in Epic workflows and interpretation of OurPractice Advisories (OPAs) preferred
- Strong understanding of ICD-10-CM coding guidelines and HCC documentation requirements
Complete Job Description
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