Risk Adjustment Coder, Specialist

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

📋 Description

• Conduct daily Risk Adjustment operations, which include reviewing medical records to report ICD-10-CM diagnosis codes for ACA and MA lines of business.

• Assist with potential CMS audits and the retrieval of medical records.

• Ensure compliance with ICD-10-CM coding guidelines, national standards, coding practices, and Risk Adjustment production standards.

• Engage in CMS Risk Adjustment audits, including Risk Adjustment Data Validation audits.

• Build relationships with key stakeholders to enhance understanding of the Risk Adjustment process.

• Aid in identifying opportunities for document improvement in provider education for MA and ACA lines of business.

• Recognize process enhancements to boost the efficiency of medical encounter reviews.

• Adhere to all relevant laws and regulations.

• Execute other responsibilities as assigned.

• Report directly to the Manager of Risk Adjustment.

⛳️ Requirements

• A bachelor's degree in a relevant field or equivalent work experience.

• Certification as a professional coder (CPC).

• At least 2 years of retrospective risk adjustment coding experience.

• Certification as a CRC or similar credentials is advantageous.

• Experience with coding across various Electronic Medical Record (EMR) systems is a plus.

• Must be a resident of the U.S., excluding Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. Territories.

• Travel may be required - up to 5%.

🏝️ Benefits

• Comprehensive employee benefits.

• Unlimited vacation policy.

• Annual performance-based bonuses.

• Medical, dental, and vision coverage.

• 11 paid holidays.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) retirement plan.

• Life and disability insurance.

• Paid wellness time and reimbursement options.

• Occasional travel for team meetings and company events.