Risk Adjustment Coding Specialist

Job Summary

Working remotely in a full-time capacity, the Risk Adjustment Coding Specialist will conduct medical record reviews, validate ICD-10-CM codes, and collaborate with healthcare providers to ensure accurate coding and documentation practices.

Key responsibilities

• Perform prospective medical record reviews to support underlying diagnoses for clinician review
• Review encounter-level patient medical records and validate ICD-10-CM codes prior to claim submission
• Stay updated on Medicare guidelines and coding regulations, and participate in staff coding education initiatives

Required qualifications

• Knowledge of ICD-10-CM coding and risk adjustment methodologies
• Experience with medical record reviews and coding validation processes
• Ability to maintain a coding accuracy rate of 95% or higher
• Familiarity with Medicare guidelines and reimbursement methodologies
• Participation in coding education and training initiatives