Risk Adjustment Coder

Risk Adjustment Coder I / Coder II (RADV Audit) Position Overview: We are seeking experienced Risk Adjustment Coders to support high-volume Risk Adjustment Data Validation (RADV) audit activities in alignment with CMS RADV program requirements and internal compliance standards. This role is responsible for reviewing and validating diagnosis coding, ensuring documentation accuracy, and supporting audit readiness initiatives related to CMS HCC risk adjustment programs. Candidates may be considered for either the Coder I or Coder II level based on experience and audit expertise. Contract Duration: *This is a short term contract from June - September with a possibility of extension!* Coder I – RADV Audit Coder Responsibilities: Review inpatient and outpatient medical records to identify and validate diagnosis codes Abstract and assign ICD-10-CM diagnosis codes based on clinical documentation Apply CMS risk adjustment guidelines and HCC model rules when validating coded conditions Confirm submitted diagnoses are supported by documentation and compliant with CMS RADV standards Verify member demographic information and beneficiary identification accuracy Ensure medical records and submission packages are complete and meet RADV audit requirements Identify coding discrepancies, unsupported diagnoses, and documentation deficiencies Maintain productivity and accuracy standards in a high-volume audit environment Document coding decisions and findings within designated systems Participate in internal QA reviews and external audit activities Maintain compliance with CMS, HIPAA, payer, and organizational coding standards Qualifications: Experience with Risk Adjustment and/or RADV audit coding Strong understanding of ICD-10-CM coding guidelines Knowledge of CMS HCC models and risk adjustment methodologies Experience reviewing inpatient and outpatient medical records Ability to work independently in a fast-paced, production-driven environment Strong attention to detail and documentation review skills Preferred certifications include CPC, CRC, CCS, RHIT, or RHIA