Risk Adjustment Coding Specialist

Job Summary

To support the Burden of Illness department, the full-time Risk Adjustment Coding Specialist will perform medical record reviews, validate ICD-10-CM codes, and collaborate with healthcare providers to ensure accurate coding and documentation, all while working remotely.

Key responsibilities

• Perform prospective medical record reviews to support underlying diagnoses for clinician review
• Validate the accuracy and completeness of ICD-10-CM codes prior to claim submission
• Conduct retrospective audits of medical records to ensure diagnosis coding accuracy and identify improvement areas

Required qualifications

• Proficient understanding of ICD-10-CM coding and Medicare guidelines
• Experience in conducting medical record reviews and coding audits
• Ability to maintain a coding accuracy rate of 95% or higher
• Knowledge of reimbursement methodologies and coding regulations
• Experience in coding education and training initiatives