About the Role
The role involves reviewing clinical documentation to validate risk adjustment data, ensuring coding accuracy and regulatory compliance while supporting financial and reporting outcomes.
Responsibilities
- Review patient medical records to confirm proper documentation of diagnoses
- Validate diagnosis coding for alignment with regulatory standards
- Support accurate risk adjustment factor calculations
- Identify gaps in clinical documentation requiring clarification
- Collaborate with healthcare providers to resolve documentation issues
- Ensure compliance with CMS guidelines and coding standards
- Maintain up-to-date knowledge of HCC coding requirements
- Participate in audits of risk adjustment data
- Contribute to quality improvement initiatives related to coding accuracy
- Use electronic health record systems to access and analyze data
- Generate reports on coding discrepancies and trends
- Work with cross-functional teams to improve data integrity
- Respond to requests for medical record reviews
- Follow established workflows for documentation validation
- Support training efforts for coding best practices
- Monitor changes in regulatory policies affecting risk adjustment
- Ensure timely completion of assigned coding reviews
- Maintain confidentiality of patient health information
- Apply ICD-10-CM coding standards accurately
- Use critical thinking to interpret complex medical records
- Document findings clearly and consistently
- Escalate complex cases according to protocol
- Meet productivity and quality benchmarks
- Stay current with industry developments in risk adjustment
- Assist in the development of internal coding guidelines
Compensation
Competitive hourly rate based on experience
Work Arrangement
Hybrid remote with required office days
Team
Part of a centralized coding and compliance team
Why This Role Matters
- Accurate risk adjustment coding directly impacts financial reporting and quality ratings for healthcare organizations.
- This role ensures that patient risk profiles are properly documented and reflected in payer data.
- Your work supports equitable healthcare funding and improves patient care outcomes.
- You will play a key part in maintaining compliance with federal regulations.
Growth Opportunities
- Opportunities exist for advancement into senior coding, auditing, or leadership roles.
- Team members are encouraged to pursue professional development and certifications.
- Exposure to regulatory changes and industry best practices is ongoing.
- Mentorship and internal training programs are available.
Not available for this position
