Risk Adjustment Coder

The Risk Adjustment HCC Coder is responsible for accurately reviewing and assigning ICD-10-CM diagnosis codes that map to Medicare Advantage and ACA Commercial Risk Adjustment models. The role ensures compliance with coding guidelines, documentation standards, quality metrics, and productivity requirements while supporting accurate risk adjustment reimbursement.

Key Responsibilities

• Assign appropriate ICD-10-CM diagnosis codes for Medicare Advantage and ACA Commercial Risk Adjustment projects.
• Review medical records and accurately map diagnoses to applicable Risk Adjustment/HCC models.
• Identify and assign flag events and Clinical Documentation Improvement (CDI) opportunities for documentation discrepancies.
• Adhere to the Standards of Ethical Coding established by the American Health Information Management Association (AHIMA).
• Follow official ICD-10-CM coding guidelines and regulatory requirements.
• Ensure compliance with HIPAA laws, regulations, and confidentiality standards.
• Maintain established quality standards of97% or higher accuracy and meet production targets.
• Stay current with coding updates, diagnosis guidelines, risk adjustment methodologies, and reimbursement reporting requirements.
• Participate in ongoing training and quality improvement initiatives.

Qualifications

• At least6 months of experience in Medical Coding, preferably inHCC Risk Adjustment Coding.
• College degree
• At least6 months of BPO experience.
• Active coding certification fromAAPC orAHIMA.
• Certified Risk Adjustment Coder (CRC) certification is preferred.
• Proficient in coding usingICD-10-CM codebooks and/or coding software.
• Strong clinical knowledge of chronic disease diagnosis, treatment, and management.
• Computer proficiency, includingMicrosoft Office applications and internet-based tools.
• Strong attention to detail, analytical skills, and ability to work independently.

Work Requirements

• Must be willing to workonsite.
• Must be willing to work on agraveyard shift.
• Work-from-home arrangement may be available when warranted by business needs.
• Must have areliable high-speed internet connection at home for remote work arrangements.

Preferred Skills

• Knowledge of Medicare Advantage and ACA Commercial Risk Adjustment programs.
• Familiarity with HCC coding methodologies and documentation standards.
• Strong communication and organizational skills.
• Ability to meet productivity and quality targets in a fast-paced environment.