Coding Analyst

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

📋 Description

• Perform precise HCC coding based on member medical records.

• Review both prospective and retrospective medical records of members, accurately assigning compliant HCC codes in accordance with ICD-10-CM coding guidelines to facilitate CMS Risk Adjustment submissions.

• Conduct structured audits of provider coding.

• Execute systematic audits on documentation and coding practices for designated physician groups and clinical personnel, identifying trends of under-documentation, unrecognized conditions, and coding errors while providing specific, actionable feedback that fosters measurable and lasting improvement.

• Provide education and training for providers.

• Create and present focused education on coding standards, CMS Risk Adjustment requirements, and best practices in clinical documentation, customizing content to meet the needs of primary care physicians, specialists, and clinical support staff within assigned CDO provider groups.

• Identify and address documentation gaps at the provider level.

• Highlight unsupported diagnoses, incomplete clinical documentation, and absent eligible conditions, effectively communicating findings to providers and care teams to close risk capture gaps at the source and reinforce documentation standards.

• Ensure adherence to CMS coding guidelines.

• Implement current CMS Risk Adjustment coding regulations, Official Guidelines for Coding and Reporting, and organizational policies in all coding and provider education activities, minimizing audit risks and ensuring the integrity of submissions.

• Achieve productivity and quality benchmarks.

• Meet daily coding productivity goals while maintaining quality scores at or above established standards, directly contributing to the CDO's RAF accuracy and performance objectives.

• Stay updated on coding and regulatory changes.

• Remain informed about ICD-10-CM updates, changes in CMS Risk Adjustment models, and HCC coding guidance, promptly applying updates to all coding tasks and revising provider education materials as necessary.

• Support data integrity and accurate reporting.

• Ensure all coded data is accurately entered into relevant systems to support downstream risk adjustment reporting, encounter data submissions, and performance analytics utilized by CDO leadership.

⛳️ Requirements

• At least 2 years of experience in medical coding, specifically in Risk Adjustment or HCC coding within a Medicare Advantage, managed care, or health plan setting.

• Proven experience with prospective and/or retrospective chart review coding.

• Proficient understanding of ICD-10-CM coding systems and CMS Risk Adjustment methodologies.

• Familiarity with electronic health record (EHR) systems and coding platforms.

• Formal training in ICD-10-CM coding and CMS Risk Adjustment methodologies, through an accredited coding program or equivalent demonstrated experience.

• Certification as a CPC (Certified Professional Coder) — AAPC; OR CCS (Certified Coding Specialist) — AHIMA; OR RHIT (Registered Health Information Technician) — AHIMA.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Professional development opportunities