, ensuring accurate documentation, compliant coding, and appropriate reimbursement.
Key Responsibilities
Review and analyze clinical documentation to identify reportable diagnoses
Assign accurate
ICD-10-CM codes
and map them to appropriate
CMS-HCC categories
Ensure compliance with
CMS risk adjustment guidelines
and official coding rules
Validate diagnoses annually for accurate risk score capture
Utilize encoder software, coding tools, and EHR systems
Submit compliant provider queries to resolve documentation gaps
Identify missed HCC opportunities and documentation deficiencies
Support internal audits, RADV reviews, and compliance initiatives
Maintain strict adherence to
HIPAA
and confidentiality standards
Required Qualifications
Active coding certification:
CRC, CPC, CCS, or equivalent
Strong knowledge of
ICD-10-CM
and
CMS-HCC risk adjustment models
Solid understanding of medical terminology, anatomy, and physiology
Experience with Medicare Advantage risk adjustment workflows
High attention to detail and strong analytical skills
Preferred Qualifications
1+ year of
HCC risk adjustment coding
experience
Familiarity with
RADV audits
Prior remote coding experience
Why Join Us
Competitive pay and flexible schedules
Fully remote opportunities available
Supportive, compliance-focused environment
Ongoing education and growth opportunities