Certified Risk Coder

What You'll Do
Review medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and compliance with CMS guidelines
Perform retrospective and prospective HCC coding reviews to identify documentation and coding opportunities
Validate ICD-10-CM codes and ensure diagnoses are clinically supported and accurately reported
Conduct coding audits and quality reviews to maintain documentation integrity and regulatory compliance
Partner with providers and clinical teams to improve documentation accuracy and risk adjustment performance
Deliver one-on-one and group education sessions on coding, documentation, and risk adjustment best practices
Communicate audit findings, coding trends, and improvement opportunities to providers and leadership
Stay current on ICD-10-CM, HCC, CMS Risk Adjustment, and payer-specific coding requirements
Support process improvement initiatives that enhance coding accuracy, compliance, and operational efficiency
Serve as a coding resource and mentor to team members, supporting training and knowledge sharing across the organization
Participate in special projects, departmental initiatives, and high-volume work efforts as assigned

Qualifications
Certified Risk Adjustment Coder (CRC) credential
At least two (2) years of risk adjustment, HCC coding, medical coding, or related healthcare experience
Working knowledge of Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC)
Proficiency with ICD-10-CM coding guidelines and CMS Risk Adjustment methodologies
Experience using Electronic Health Records (EHRs), coding software, and Microsoft Office applications
Excellent communication and presentation skills with the ability to educate providers and office staff
Strong analytical, organizational, and problem-solving skills with exceptional attention to detail
Ability to work independently in a remote environment while collaborating effectively with cross-functional teams

You are a great fit if
Active AAPC or AHIMA certification required (CPC, CCS-P, CCS, or equivalent)
Three (3)+ years of Risk Adjustment or Medicare Advantage coding experience
Experience conducting coding audits and documentation reviews
Experience educating providers on coding and documentation improvement initiatives
Previous experience supporting value-based care, population health, or provider group environments
Advanced presentation and PowerPoint skills