Job Description

About the Role

We are seeking an experienced Risk Adjustment Coder with strong knowledge of HCC coding, CMS guidelines, RAF score calculation, and accurate clinical documentation review. The ideal candidate will be CRC/CPC certified and able to deliver high-quality coding with zero-compromise compliance standards.

Key Responsibilities

• Review and analyze medical records, charts, and documentation to assign accurate ICD-10-CM diagnosis codes for Risk Adjustment (HCC) models.
• Ensure coding accuracy that aligns with CMS, DX-HCC, and internal compliance guidelines.
• Validate clinical documentation to support submitted diagnoses and identify documentation gaps.
• Work closely with QA/clinical teams to resolve coding queries and discrepancies.
• Maintain productivity and accuracy standards as per organizational expectations.
• Participate in continuous audits, feedback sessions, and training programs to improve coding quality.
• Assist in identifying trends, risk areas, and opportunities for documentation improvement.
• Maintain confidentiality and compliance with HIPAA regulations.

Required Qualifications

• Bachelor’s degree Life Sciences, Nursing, Pharmacy, or related field.
• Minimum 2+ years of experience in Risk Adjustment / HCC Coding.
• CRC or CPC certification is mandatory.
• Strong understanding of CMS risk adjustment models, ICD-10 guidelines, and clinical terminology.

Skills & Competencies

• Excellent knowledge of ICD-10-CM, HCC mapping, and coding compliance.
• Strong analytical ability and attention to detail.
• Ability to interpret physician documentation accurately.
• Good communication and written skills.
• Familiarity with EMR/EHR systems and coding platforms.