Risk Adjustment Analyst

Job Description

Job Description

Certified Risk Adjustment Coder

Location: Remote/Hybrid - ONLY STATES FLORIDA, GEORGIA, SOUTH CAROLINA, TEXAS 
Department: Primary Care
Reports To: Director of Risk Adjustment / Population Health Manager

Position Summary

The Certified Risk Adjustment Coder is responsible for reviewing medical records, identifying and validating diagnoses, and ensuring accurate risk adjustment coding in accordance with CMS-HCC guidelines. This role partners closely with primary care providers, clinical staff, and leadership to improve documentation accuracy, support value-based care initiatives, and ensure appropriate reimbursement for patient populations.

Essential Duties and Responsibilities

• Review medical records to identify opportunities for accurate risk adjustment coding and documentation.
• Perform prospective and retrospective chart reviews to ensure compliance with CMS-HCC, ICD-10-CM, and payer-specific guidelines.
• Validate chronic conditions, disease burden, and documentation requirements.
• Collaborate with primary care physicians, nurse practitioners, and care teams to clarify diagnoses and improve documentation practices.
• Educate providers on risk adjustment coding requirements and best practices.
• Monitor coding trends, quality metrics, and coding accuracy.
• Assist in closing care gaps and supporting value-based care initiatives.
• Conduct coding audits and prepare findings for leadership review.
• Maintain compliance with Medicare Advantage, commercial payer, and regulatory requirements.
• Participate in quality improvement projects relating to documentation and coding performance.

QualificationsRequired

• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification.
• Minimum of 2 years of risk adjustment coding experience.
• Strong understanding of:
  • CMS-HCC Risk Adjustment Model
  • ICD-10-CM Coding Guidelines
  • Medicare Advantage Programs
  • Medical Terminology and Anatomy
• Experience reviewing primary care medical records.
• Proficiency with electronic health record (EHR) systems.
• Strong analytical and communication skills.

Preferred

• Experience in Value-Based Care or Population Health.
• Experience working with Medicare Advantage populations.
• Knowledge of quality programs such as HEDIS and STAR Ratings.
• Bachelor's degree in Health Information Management, Healthcare Administration, or related field.

Physical Requirements

• Prolonged periods of sitting and computer use.
• Ability to review electronic medical records and reports for extended periods.

Benefits

• Competitive salary
• Health, Dental, and Vision Insurance
• Paid Time Off
• 401(k) with Company Match
• Professional Development Opportunities
• Remote Work Flexibility (if applicable)

Preferred Job Posting Summary

Certified Risk Adjustment Coder

PCC Medical Holdings is seeking an experienced Certified Risk Adjustment Coder to support our primary care practices. The ideal candidate will have extensive knowledge of CMS-HCC risk adjustment methodologies, ICD-10 coding, and Medicare Advantage programs. This individual will work closely with providers and clinical staff to ensure accurate documentation and coding, improve risk score accuracy, and support value-based care initiatives across our patient population. Strong analytical skills, coding certification, and healthcare experience are required.