Copy of Risk Adjustment Coder

Accountabilities:: Review patient medical records, including medical histories, physical examinations, physician orders, progress notes, consultation reports, diagnostic results, operative reports, discharge summaries, and other clinical documentation. Perform prospective, retrospective, and concurrent chart reviews using Hierarchical Condition Category (HCC) risk adjustment coding guidelines and M.E.A.T. criteria to validate diagnosis accuracy and documentation support. Conduct pre-visit and post-visit audits with assigned providers to ensure diagnoses are accurately captured and documented at the highest appropriate level of specificity. Establish and maintain strong working relationships with physicians and clinical office staff through regular communication, follow-ups, and scheduled chart review meetings. Obtain medical records from internal and external healthcare providers to support accurate documentation and respond to health plan audit requests. Educate physicians and administrative staff on appropriate coding practices, billing requirements, documentation standards, and the resolution of ambiguous or incomplete medical records. Identify missing documentation, coding opportunities, inaccurate diagnoses, and potential compliance issues, investigating discrepancies and escalating concerns when necessary. Conduct onsite provider visits to deliver coding education, share chart review feedback, and promote continuous improvements in documentation quality. Ensure compliance with applicable federal, state, and local regulations, as well as risk adjustment coding standards and reporting requirements. Support accurate CPT, HCPCS Level II, ICD-10-CM, and modifier coding, while applying knowledge of HEDIS codes and NCQA guidelines. Meet established daily productivity targets while consistently maintaining an average coding accuracy rate of at least 95%. Perform additional responsibilities as assigned to support the broader clinical and operational teams. Requirements: High school diploma or associate degree required. Clinical education or professional background as an RN, LVN, LPN, foreign medical graduate, or pharmacist is preferred. At least 3 years of professional experience in ICD-10 coding. Minimum of 3 years of experience in Medicare risk adjustment coding. At least 2 years of experience conducting prospective, concurrent, and retrospective risk adjustment reviews. Minimum of 1 year of experience providing coding and documentation education to healthcare providers. At least 1 year of experience with CPT and Evaluation and Management (E&M) coding. At least 1 year of experience in outpatient primary care coding and medical record reviews. Required professional certification such as CPC, CPMA, CRC, CCS-P, CCS, RHIA, or RHIT. Strong understanding of HCC risk adjustment methodologies, M.E.A.T. documentation criteria, ICD-10-CM coding standards, and regulatory compliance requirements. Knowledge of CPT, HCPCS Level II, modifiers, HEDIS coding, and NCQA guidelines. Excellent analytical skills, attention to detail, and the ability to identify documentation inconsistencies and coding discrepancies. Strong communication and interpersonal skills, with the ability to educate providers and collaborate effectively with multidisciplinary healthcare teams. Ability to manage competing priorities, meet daily production expectations, and consistently maintain high coding accuracy. Familiarity with Elation EMR is preferred. Spanish-English bilingual proficiency is an advantage. Benefits: Competitive compensation. Comprehensive medical and dental insurance coverage. Free mental health services and life coaching for employees and their dependents. Paid holidays. Generous paid time off (PTO). Paid community service day. Paid parental and family leave. Paid bereavement leave. 401(k) retirement savings plan with employer matching. Purpose-driven work contributing to improved healthcare access and quality for underserved senior communities. Inclusive and collaborative workplace culture that values diversity, professional development, and employee well-being.