Medical & Healthcare - CW Risk Adjustment Coder

CW Risk Adjustment Coder

Experienced Risk Adjustment Coder with a strong background in Medicare Advantage Risk Adjustment coding and ACA Risk Adjustment coding. This position supports ongoing risk adjustment initiatives through accurate coding, medical record review, documentation validation, and quality assurance activities. The coder will help ensure compliance with CMS and other regulatory requirements while supporting the organization's risk adjustment accuracy and revenue integrity goals. Candidates should have demonstrated experience with CMS-HCC coding methodologies, medical record review, and risk adjustment documentation validation. This position works under general supervision and does not have direct supervisory responsibilities.

Key Responsibilities:

• Review and assess medical record documentation and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs.
• Perform retrospective and prospective coding reviews to identify supported HCC conditions.
• Evaluate medical records for coding accuracy, completeness, and compliance with CMS Risk Adjustment guidelines.
• Conduct quality assurance reviews and coding audits to ensure coding accuracy and regulatory compliance.
• Identify coding trends and provide feedback regarding documentation improvement opportunities.
• Support risk adjustment data validation, chart review, and audit initiatives.
• Collaborate with business partners and stakeholders to support risk adjustment and coding accuracy goals.
• Maintain productivity and quality standards while meeting established deadlines.
• Assist with gap identification and closure initiatives for Medicare and ACA populations.
• Document coding results in designated systems and maintain accurate records.
• Perform other duties as assigned.

Required Qualifications:

• High School Diploma or GED required.
• Minimum three (3) years of medical coding experience.
• Strong Medicare Advantage Risk Adjustment coding experience required.
• Experience with CMS-HCC coding methodologies and risk adjustment programs.
• Experience performing medical record reviews and coding validation activities.
• Ability to work independently in a remote environment while maintaining productivity and quality expectations.

Preferred Qualifications:

• ACA Risk Adjustment coding experience.
• CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist), RHIT, RHIA, or similar coding certification.
• Experience conducting coding audits and quality assurance reviews.
• Experience supporting Risk Adjustment Data Validation (RADV) audits.
• Experience within a managed care, health insurance, or Medicare Advantage environment.

Knowledge, Skills, and Abilities:

• Advanced knowledge of ICD-10-CM coding guidelines.
• Strong understanding of Medicare Advantage Risk Adjustment and HCC coding methodologies.
• Working knowledge of ACA Risk Adjustment principles.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and organizational skills.
• Ability to interpret complex clinical documentation.
• Strong written and verbal communication skills.
• Intermediate proficiency with Microsoft Office applications.
• Experience working with Electronic Medical Record (EMR) systems.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

EEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."