Risk Adjustment Coder

Location: REMOTE 

Job Summary

Analyzes and translates concurrent, prospective, and retrospective medical and clinical diagnoses, procedures, injuries, and illnesses into Medicare Risk Adjustment (MRA) ICD-10 codes and Hierarchical Condition Categories (HCCs). Completes assignments with an emphasis on completeness, accuracy, and supporting clinical care plans as it pertains to Risk Adjustment Data Validation (RADV) timelines.
Essential Functions

• Accurately validates and abstracts diagnosis codes from provider documentation in medical records.
• Analyzes and translates moderately complex medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes, adhering to the CMS Risk Adjustment Models.
• Conducts peer quality reviews to identify incorrect coding, providing feedback and education on audit results.
• Monitors HCC coding performed by outside vendors by performing quality audits to ensure accuracy.
• Exhibits and utilizes a full understanding of current client coding guidelines and relevant federal regulations using current ICD-10-CM materials, the Federal Register, and other pertinent materials.
• Ensures compliance with all applicable federal, state, and local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
• Works on Special Projects.
• Demonstrates analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
• Maintain 95% quality, accuracy, and completeness.

Job Requirements

• High School Diploma or GED (Required)
• 2-4 years relevant work experience (Preferred)
• AAPC or AHIMA Certification (CPC, CRC, CCS) (Required)
• Certified Risk Adjustment Coder (Preferred)

Knowledge, Skills and Abilities

• Knowledgeable of medical and clinical terminology, disease processes, and pharmacology.
• ICD-10-CM proficient

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