Risk Adjustment Coder
Job Description: Risk Adjustment Coder Job Summary We are seeking an experienced and certified Risk Adjustment Coder to perform medical record reviews, coding validation, and audit activities in accordance with applicable CMS guidelines. The ideal candidate will have strong knowledge of ICD-10-CM coding, risk adjustment methodologies, medical record documentation, and regulatory compliance requirements.
Key Responsibilities
- Review medical records to identify and validate reportable diagnoses.
- Perform first-pass and second-pass coding reviews and audits, as applicable.
- Ensure accurate diagnosis code assignment in accordance with ICD-10-CM guidelines and CMS requirements.
- Verify that coded diagnoses are supported by appropriate medical record documentation.
- Identify coding discrepancies, documentation gaps, and potential compliance issues.
- Maintain accurate audit documentation and record findings, errors, and recommendations.
- Follow established coding guidelines, quality standards, and compliance protocols.
- Meet productivity, accuracy, and quality performance targets.
- Collaborate with internal teams to resolve coding discrepancies and support audit requirements.
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