Risk Adjustment Coder
Type: Temp-to-Perm
Schedule: Full-time, Monday–Friday
Location: Hybrid – Remote with 1–2 days per week in-office
Compensation: $24.50 – $27.00 per hour
Position Summary
The Risk Adjustment Coder is responsible for conducting medical record reviews, ensuring accurate and compliant assignment of ICD-10 codes, and supporting Medicare and Medicaid Risk Adjustment initiatives. This position plays a key role in coding, auditing, compliance, and provider engagement, contributing to accurate risk scoring, regulatory adherence, and improved health outcomes. The coder works under moderate supervision and may provide support or leadership on smaller projects.
Key Responsibilities
Conduct coding reviews independently on medical record documentation to assign and/or audit ICD-10 codes in accordance with CMS HCC methodology.
Ensure completion of reviews and accurate scoring based on monthly department targets.
Maintain up-to-date knowledge of coding/billing guidelines, CMS/DOH regulations, and federal/state initiatives.
Perform compliance audits and provide audit trails for all identified HCCs.
Identify unsupported diagnoses/HCCs for RADV projects; escalate deficiencies to management.
Monitor, assess, and enhance documentation accuracy to support risk adjustment and quality initiatives.
Collaborate with providers to improve documentation consistency and coding accuracy; support education and training efforts.
Report audit findings, trends, and irregularities to leadership; recommend corrective actions and process improvements.
Support enterprise-wide initiatives by collaborating with compliance, SIU, claims, and assessment teams, including efforts related to fraud, waste, and abuse.
Participate in Medicaid Risk Adjustment initiatives, including auditing CHA assessments, monitoring risk scores, and ensuring compliance with CMS and DOH standards.
Assist in developing and delivering coding education, training resources, and presentations for internal teams and providers.
Qualifications
Direct hands-on Risk Adjustment coding experience (Medicare/Medicaid required).
In-depth knowledge of ICD-10-CM, HCC methodology, and CMS Risk Adjustment guidelines.
Experience with RADV audits, CHA assessments, and compliance standards.
Strong analytical, organizational, and documentation skills.
Proficiency in EMR systems, coding/audit tools, and Microsoft Office.
Ability to work independently under moderate supervision while collaborating across teams.
Excellent communication skills for provider engagement and internal education.
Coding certification (CPC, CRC, CCS, etc.) preferred but not required.
Please send resumes to mfesinstine@phaxis.com
An Equal Employment Opportunity Employer