Healthcare Risk Adjustment Coder

Elite Technical is seeking an experienced Risk Adjustment Coder with a strong background in Medicare Advantage Risk Adjustment coding and ACA Risk Adjustment coding.

Responsibilities

• Review and assess medical record documentation and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs.
• Perform retrospective and prospective coding reviews to identify supported HCC conditions.
• Evaluate medical records for coding accuracy, completeness, and compliance with CMS Risk Adjustment guidelines.
• Conduct quality assurance reviews and coding audits to ensure coding accuracy and regulatory compliance.
• Identify coding trends and provide feedback regarding documentation improvement opportunities.
• Support risk adjustment data validation, chart review, and audit initiatives.
• Collaborate with business partners and stakeholders to support risk adjustment and coding accuracy goals.
• Maintain productivity and quality standards while meeting established deadlines.
• Assist with gap identification and closure initiatives for Medicare and ACA populations.
• Document coding results in designated systems and maintain accurate records.

Requirements

- Education: High School Diploma or GED is required.
- Minimum three (3) years of medical coding experience.
- Strong Medicare Advantage Risk Adjustment coding experience required.
- Experience with CMS-HCC coding methodologies and risk adjustment programs.
- Experience performing medical record reviews and coding validation activities.
- Experience interpreting clinical documentation and assigning accurate ICD-10-CM diagnosis codes.
- Ability to work independently in a remote environment while maintaining productivity and quality expectations.
Advanced knowledge of ICD-10-CM coding guidelines.
- Strong understanding of Medicare Advantage Risk Adjustment and HCC coding methodologies.
- Working knowledge of ACA Risk Adjustment principles.
- Strong analytical and problem-solving skills.
- Excellent attention to detail and organizational skills.
- Ability to interpret complex clinical documentation.
- Strong written and verbal communication skills.
- Intermediate proficiency with Microsoft Office applications.
- Experience working with Electronic Medical Record (EMR) systems.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

Preferred Qualifications

• ACA Risk Adjustment coding experience.
• CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist), RHIT, RHIA, or similar coding certification.
• Experience conducting coding audits and quality assurance reviews.
• Experience supporting Risk Adjustment Data Validation (RADV) audits.
• Experience within a managed care, health insurance, or Medicare Advantage environment.