Summary Description
We are seeking detail-oriented Risk Adjustment Coders who specialize in accurately capturing patient diagnoses using standardized codes to support risk adjustment models. The ideal candidate will have expertise in coding practices, a deep understanding of clinical documentation, and a commitment to compliance with industry regulations. Your role will be critical in ensuring healthcare providers receive accurate reimbursements for patient care.

Responsibilities

• Analyze clinical documentation and assign accurate ICD-10-CM codes for risk adjustment.

• Validate HCC (Hierarchical Condition Category) coding to ensure accuracy and compliance.

• Identify gaps in documentation and communicate with providers for clarification.

• Stay updated with CMS (Centers for Medicare & Medicaid Services) guidelines and other industry standards.

• Support audits by reviewing coded data and documentation for consistency and correctness.

Skills and Qualifications

• Certification: CPC, CRC, or equivalent certification from AAPC or AHIMA.

• 2+ years of experience in medical coding, with at least 1 year in risk adjustment.

• Strong knowledge of HCC models, CMS guidelines, and ICD-10-CM coding.

• Excellent analytical and problem-solving skills.

• Ability to work independently and meet deadlines.

Work Location

• Remote/Hybrid, depending on organizational requirements.