Risk Adjustment Coder

Job Summary

We are seeking an experienced and certified Risk Adjustment Coder to support first-pass and second-pass auditing activities for CMS Risk Adjustment Data Validation (RADV) audits. The ideal candidate will have strong knowledge of risk adjustment coding guidelines, medical record documentation, and CMS compliance requirements, along with the ability to accurately review and validate diagnosis codes.

Key Responsibilities

• Perform first-pass and second-pass audits of medical records to support CMS RADV audits.
• Review medical documentation to validate diagnosis codes and ensure appropriate code assignment.
• Verify the accuracy, completeness, and compliance of risk adjustment coding in accordance with applicable CMS guidelines.
• Identify coding discrepancies, documentation gaps, and potential compliance issues.
• Ensure diagnoses are supported by appropriate medical record documentation.
• Apply established risk adjustment coding guidelines and quality standards during audits.
• Maintain accurate audit records and document findings, errors, and recommendations.
• Meet established productivity, accuracy, and quality benchmarks.
• Collaborate with internal teams to resolve coding discrepancies and support audit requirements.

Required Qualifications and Skills

• Certifications: Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC).
• Experience: Minimum of 5 years of risk adjustment coding experience.
• Technical Skills: Proficiency in Microsoft Office Suite, including Excel, Word, and Outlook.
• Strong knowledge of CMS risk adjustment guidelines and RADV audit processes.
• Experience performing medical record reviews and validating diagnosis codes.
• Excellent attention to detail and analytical skills.
• Strong written and verbal communication skills.
• Ability to work independently and manage priorities effectively in a remote work environment.