Certified Risk Coder

This is a fully remote position, open to applicants in California.

📋 Description

• Assess medical records and provider documentation to ensure proper documentation of risk-adjusting diagnoses and adherence to CMS regulations.

• Conduct both retrospective and prospective HCC coding reviews to pinpoint documentation and coding enhancement opportunities.

• Validate ICD-10-CM codes, ensuring diagnoses are clinically substantiated and accurately reported.

• Execute coding audits and quality reviews to uphold documentation integrity and compliance with regulations.

• Collaborate with providers and clinical teams to enhance the accuracy of documentation and improve risk adjustment outcomes.

• Provide individual and group training sessions on coding, documentation, and best practices for risk adjustment.

• Present audit results, coding trends, and opportunities for improvement to providers and leadership teams.

• Remain updated on ICD-10-CM, HCC, CMS Risk Adjustment, and payer-specific coding standards.

• Assist in process improvement initiatives aimed at boosting coding accuracy, compliance, and operational efficiency.

• Act as a coding resource and mentor for team members, facilitating training and knowledge dissemination throughout the organization.

• Engage in special projects, departmental initiatives, and high-volume work assignments as needed.

⛳️ Requirements

• Certified Risk Adjustment Coder (CRC) credential is required.

• Minimum of two (2) years of experience in risk adjustment, HCC coding, medical coding, or a related healthcare field.

• Familiarity with Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC).

• In-depth understanding of ICD-10-CM coding guidelines and CMS Risk Adjustment methodologies.

• Proficient in using Electronic Health Records (EHRs), coding software, and Microsoft Office applications.

• Exceptional communication and presentation skills, capable of educating providers and office personnel.

• Strong analytical, organizational, and problem-solving abilities, with a keen attention to detail.

• Capacity to work independently in a remote setting while effectively collaborating with cross-functional teams.

• Active certification from AAPC or AHIMA is required (CPC, CCS-P, CCS, or equivalent).

• Over three (3) years of experience in Risk Adjustment or Medicare Advantage coding.

• Experience in conducting coding audits and documentation assessments.

• Background in educating providers on coding and documentation enhancement initiatives.

• Previous experience in supporting value-based care, population health, or provider group settings.

• Advanced skills in presentation and PowerPoint.

🏝️ Benefits

• Remote position based in the US.

• Preference for candidates located in the West or Central time zones.

• Equal Employment Opportunity and Affirmative Action employer.

• Reasonable accommodations available for applicants with disabilities.