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 documentation and coding in a remote setting.

Key responsibilities

• Perform prospective medical record reviews for clinical indicators and present findings to clinicians
• Validate and review ICD-10-CM diagnosis codes in real time prior to claim submission
• Conduct retrospective audits of medical records to ensure accuracy and completeness of diagnosis coding

Required qualifications

• Proven experience in risk adjustment coding and medical record review
• Strong knowledge of ICD-10-CM coding guidelines and Medicare regulations
• Ability to maintain a coding accuracy rate of 95% or higher
• Experience in conducting coding education and training for staff
• Familiarity with data analysis and reporting in healthcare settings