The MRA Chart Reviewer is responsible for reviewing medical records to identify, validate, and capture accurate diagnoses in support of Medicare Risk Adjustment (MRA) and HCC coding. This role ensures documentation supports all reported conditions and complies with CMS and ICD-10-CM guidelines.
Key Responsibilities
Review patient medical charts for completeness, accuracy, and compliance with CMS Risk Adjustment guidelines
Identify and validate HCC (Hierarchical Condition Category) diagnoses
Ensure all chronic and acute conditions are properly documented and coded
Perform retrospective and prospective chart reviews
Collaborate with providers to clarify documentation when needed
Identify documentation gaps and provide feedback to providers
Maintain productivity and quality standards
Follow ICD-10-CM, CMS, and internal coding policies
Support audit preparation and compliance initiatives
Qualifications
Medical knowledge (MD, RN, or other equivalent medical/clinical credentials/experiences)
Knowledge of ICD-10-CM and CMS Risk Adjustment (HCC) coding (CPC, CRC, CDIP, or equivalent preferred)
Experience with medical chart reviews (minimum 1-2 years preferred)
Familiarity with EHR systems (eCW, Epic, Athena, etc.)
Strong attention to detail and analytical skills
Ability to work independently and meet productivity targets
Preferred Skills
Experience with Medicare Advantage and value-based care programs
Knowledge of RAF score methodology
Understanding of CMS audit processes (RADV, OIG)
Excellent written and verbal communication skills
Performance Metrics
Chart review productivity targets
Coding accuracy and audit pass rate
Turnaround time
Provider query resolution rate