Job Summary
We are seeking newly certified Risk Adjustment Medical Coders to join our team. The ideal candidate will be responsible for reviewing medical records to identify, code, and validate diagnoses based on risk adjustment models such as HCC (Hierarchical Condition Categories). The coder must ensure accuracy, compliance, and completeness in coding to support optimal reimbursement and risk score accuracy.
Essential Duties and Responsibilities
- Analyze medical records to assign accurate ICD-10-CM codes according to risk adjustment guidelines (HCC, RxHCC, CDPS, etc.).
- Ensure all documented diagnoses are supported by proper clinical documentation.
- Identify and capture chronic conditions that impact risk scores.
- Adhere to official coding guidelines, CMS (Centers for Medicare & Medicaid Services) regulations, and internal policies.
- Ensure all coding meets risk adjustment and compliance standards to prevent coding discrepancies and audits.
- Maintain a high level of coding accuracy to meet organizational quality standards.
- Stay updated on risk adjustment methodologies, coding guidelines, and industry changes.
- Participate in training sessions, webinars, and certifications to maintain expertise in risk adjustment coding.
Qualifications & Skills
- Certification: CPC, CRC (Certified Risk Adjustment Coder), or equivalent coding certification is required.
- Healthcare Background: Graduate of BS Nursing / Registered Nurse Required.
- Experience: Risk Adjustment experience is not required, newly certified medical coders are most welcome
- Knowledge: Strong understanding of ICD-10 CM coding, HCC risk adjustment models, and medical terminology.
- Attention to Detail: Strong analytical and problem-solving skills to ensure accuracy in coding and documentation review.
- Work Ethic: Ability to work independently and meet productivity and quality targets in a fast-paced environment.
