Risk Adjustment Coder Specialist
Core
Review medical records to report ICD-10-CM diagnosis codes for Medicare Advantage and Affordable Care Act lines of business, ensuring compliance with CMS standards and participating in audits.
Role type
Senior Specialist, Risk Adjustment Coder
Builds
Accurate risk adjustment data submissions for CMS
Domain
Health Insurance / Medical Coding
Required skills
ICD-10-CM coding, Risk Adjustment coding, Medical record review, CMS audit preparation, Process improvement, Compliance with coding guidelines
Preferred skills
Certified Risk Adjustment Coder (CRC), EMR system experience
Technologies
ICD-10-CM, CMS systems, EMR systems
Responsibilities
Review medical records to report ICD-10-CM diagnosis codes, Maintain compliance with national coding standards, Participate in CMS audits, Identify document improvement opportunities for provider education, Identify process improvements to enhance review efficiency
Seniority
Senior, hands-on IC
