Risk Adjustment Analyst

Job Summary

To enhance healthcare outcomes, the full-time Risk Adjustment Analyst will analyze and audit medical records for insurance compliance, manage Hierarchical Condition Categories (HCC) for claims, and conduct pre-visit planning reviews, all while working remotely.

Key responsibilities

• Perform payer audits and validate provider information as required by Value Care contracts
• Review and reorder HCCs in the top 12 diagnoses for accurate claim billing
• Conduct pre-visit medical record reviews to ensure proper documentation of HCC conditions

Required qualifications

• High school diploma or GED required
• Successful completion of the OP CDI Proficiency Test
• One of the following certifications: AHIMA, AAPC, CPC, CRC, ACDIS, RN, LPN, NP, PA, or MD
• Minimum of twelve months of outpatient coding or nursing experience in an ambulatory care setting
• Strong knowledge of medical record documentation requirements and coding guidelines