Government Programs Risk Adjustment Coder
Employment Information
Job Description
Government Programs Risk Adjustment Coder ensuring accurate diagnosis coding for Medicare Advantage and ACA lines. Collaborating with teams to improve clinical documentation and maintain compliance.
Responsibilities:
- Perform comprehensive reviews of medical records to ensure compliance with CMS and departmental risk adjustment guidelines
- Conduct chart audits to identify undocumented or underreported chronic conditions
- Collaborate with internal teams and external stakeholders to support accurate diagnosis capture and improve clinical documentation
- Maintain productivity and accuracy benchmarks, ensuring all diagnosis coding is accurate, complete, specific, and appropriate
- Stay current on risk adjustment policies, HCC updates, and official coding guidelines
Requirements:
- 3 years' experience with CMS-HCC and HHS-HCC risk adjustment coding
- Proficiency in ICD-10-CM coding with a strong focus on risk adjustment and HCC coding methodologies
- Thorough knowledge of the CMS Medicare risk algorithm (CMS HCC) and the ACA risk algorithms (HHS HCC) and coding guidelines
- Certified Risk Adjustment Coder (CRC) credential required
- High School Diploma or GED
- Proficient with common EMR systems e.g., Allscripts, EPIC, AthenaHealth, PracticeFusion, Medent
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off, Holidays, and Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Professional development and training opportunities
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