Certified Risk Adjustment Coder

Medical Billing and CodingMedical Billing and CodingFull TimeRemoteTeam 1-10Since 2023H1B No SponsorCompany Site LinkedIn

Location

California

Posted

39 days ago

Salary

$24 - $27 / hour

Professional Certificate1 yr expEnglish

Job Description

• Review participant medical records and provider documentation to identify, validate, and code risk-adjustable diagnoses in accordance with CMS-HCC v24 and v28 guidelines. • Ensure complete, accurate, and compliant ICD-10-CM coding with a primary focus on concurrent and retrospective reviews (with flexibility for pre-visit planning as needed). • Draft and submit compliant provider queries to clarify documentation and support accurate coding. • Track and follow through on open queries—engaging with providers, monitoring responses, and closing them out appropriately. • Apply strong critical thinking skills to resolve complex documentation and coding scenarios. • Maintain clear, professional communication with providers and internal teams to support documentation completeness. • Stay current with CMS, OIG, and industry regulations related to risk adjustment and coding compliance.

Job Requirements

Active CRC (Certified Risk Adjustment Coder) required.
Minimum of 1 year of experience in risk adjustment coding.
In-depth knowledge of ICD-10-CM and CMS-HCC models v24 and v28.
Demonstrated ability to work independently, stay organized, and follow through on tasks with minimal oversight.
Strong written and verbal communication skills, with the ability to engage providers in a professional and solutions-oriented manner.
High attention to detail and ability to critically analyze clinical documentation.
Proficiency with electronic health records (EHR) and Microsoft Excel.
Aligns with our purpose and our values, and is excited about living those out in daily practice