Risk Adjustment Coding Specialist I
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Job Description
Risk adjustment coding specialist validating medical diagnoses and supporting compliant Medicare documentation. Reviewing records, HCC coding, and provider documentation under established guidelines.
Responsibilities:
- Review medical records to identify clinical documentation supporting diagnosis reporting and risk adjustment activities
- Validate diagnosis codes selected by providers to ensure documentation supports accurate and compliant coding
- Support prospective and concurrent coding review activities designed to improve diagnosis capture and documentation quality
- Collaborate with providers and internal stakeholders to obtain clarification regarding documentation requirements
- Maintain knowledge of ICD-10-CM coding guidelines, Medicare risk adjustment principles, and documentation requirements
- Participate in coding education, training programs, and quality improvement initiatives
- Meet established productivity and quality standards while maintaining coding accuracy
- Protect the confidentiality and integrity of patient information in accordance with organizational policies and regulatory requirements
- Maintain accurate records of completed work and support timely capture of documented patient conditions
- Work under close supervision, follow established processes and procedures, and escalate issues outside standard protocols
Requirements:
- High school diploma or GED required
- Active coding credential through AAPC or AHIMA required; CRC preferred
- Minimum one year of healthcare, outpatient, coding, or related medical experience preferred
- Working knowledge of ICD-10-CM coding conventions and medical terminology
- Foundational understanding of anatomy, physiology, disease processes, and pharmacology
- Familiarity with Medicare risk adjustment and HCC coding concepts preferred
- Proficiency using electronic health record systems
- Strong attention to detail and analytical skills
- Ability to work within established procedures and prioritize assigned work
- Commitment to maintaining professional certification and ethical coding standards
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