Risk Analyst

Job Description

Job Description

Job Title: Risk Adjustment Coding Oversight Specialist (Risk Analyst) Job Description

This role focuses on retrospective chart review and coding oversight for highly regulated Medicare Advantage risk adjustment programs. You will lead quality assurance and vendor oversight activities to ensure accurate, complete, and compliant diagnosis coding. The position requires strong attention to detail, clear communication, and the ability to manage multiple projects and quality assurance levels in a high-volume environment with minimal supervision.

• Conduct quality oversight audits of risk adjustment coding performed by both internal coders and external vendor coders, ensuring accuracy, completeness, and compliance with applicable guidelines.
• Perform detailed retrospective chart reviews to validate and assess diagnosis coding for risk adjustment purposes.
• Identify and appropriately add or delete diagnoses based on thorough medical record review results, ensuring accurate capture of all relevant conditions.
• Document and report quality assurance findings, trends, and issues to senior coding oversight specialists and leadership in a clear, structured manner.
• Support departmental goals by helping ensure vendor partners meet established service level agreements (SLAs) and quality standards.
• Collaborate closely with vendor contacts and internal team members to address coding issues, clarify documentation, and improve coding quality.
• Utilize AI-based coding tools and vendor platforms to review, validate, and audit coded data efficiently.
• Participate in multiple concurrent risk adjustment projects, adjusting priorities as needed while maintaining high accuracy and productivity.
• Perform additional risk adjustment and quality assurance projects as assigned to support evolving business needs.
• Contribute to continuous improvement of coding oversight processes by sharing observations, best practices, and recommendations.

• Current CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential.
• Current CRC (Certified Risk Coder) certification.
• Minimum of 2+ years recent experience in medical record review, risk adjustment, diagnosis coding, and/or quality auditing.
• 2–3 years of hands-on experience coding risk adjustment, with the ability to hit the ground running with limited training.
• Proficiency using AI coding tools or similar artificial intelligence–based coding software.
• Strong knowledge of risk adjustment coding principles and guidelines, particularly in Medicare Advantage or similar regulated programs.
• Demonstrated ability to work effectively in a high-volume, production-oriented environment.
• Proven capability to work independently with minimal supervision while maintaining high accuracy and productivity.
• Excellent attention to detail and accuracy in reviewing and validating medical records and diagnosis codes.
• Effective written and verbal communication skills to report findings and collaborate with internal and external stakeholders.
• High school diploma or equivalent.

• Associate’s degree from an accredited college or university.
• Experience with Medicare and/or commercial risk adjustment processes.
• Experience and understanding of electronic medical and health records systems.
• Experience conducting formal quality assurance reviews for coding or risk adjustment.
• Familiarity with multiple levels of quality assurance and vendor oversight structures.
• Comfort working with AI-driven tools and vendor-specific coding platforms.
• Flexibility to manage multiple projects and shifting priorities concurrently.
• Strong organizational skills and the ability to maintain consistent documentation of audit results and trends.

This position supports risk adjustment projects for Medicare Advantage and potentially other risk adjustment lines of business. You will work with AI-based coding tools and a vendor-provided coding platform to perform retrospective chart reviews and quality oversight. The role is structured as a 6–9 month engagement with the possibility of extension or conversion to a longer-term opportunity, depending on business needs. Standard hours are approximately 8:00 a.m. to 5:00 p.m. (Central Time), with flexibility for earlier shifts such as 6:30 a.m. to 3:30 p.m., and an expectation that team members are online by 9:00 a.m. Central Time. The team discourages working past 5:00 p.m. to support work–life balance. The position can be performed from any location and time zone within the United States, and you will collaborate remotely with team members based in multiple states. You will report to a coding oversight leader and work closely with a senior coder and vendor contacts through regular, informal meetings. Initial training spans approximately two days and is led primarily by the senior coder and oversight leader, focusing on onboarding to workflows, tools, and quality expectations. The environment emphasizes high productivity, accuracy, collaboration, and continuous quality improvement. Dress code is typical for a professional remote work setting and may be adjusted as needed for virtual meetings.

This is a Contract position based out of Houston, TX.

The pay range for this position is $35.00 - $35.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Sep 23, 2026.

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing® Platinum Award winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on ziprecruiter.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.