Risk Adjustment Coder

Position Overview

This is a fully remote, contract position.

Medical Coding Coach is seeking an experienced Remote Risk Adjustment Coder to support Initial Validation Audit (IVA) ACA, ACA Risk Adjustment, and Medicare Advantage coding projects. The ideal candidate will review and code medical records to accurately capture diagnoses in accordance with ICD-10-CM coding guidelines, CMS Risk Adjustment requirements, HHS-HCC methodologies, and client-specific coding standards.

This role requires strong clinical coding knowledge, attention to detail, and the ability to work independently in a remote environment while meeting established productivity and quality expectations.

Key Responsibilities

• Perform retrospective review of medical records for IVA ACA, ACA Risk Adjustment, and Medicare Advantage projects.
• Review and validate diagnoses submitted for Risk Adjustment programs.
• Accurately assign ICD-10-CM diagnosis codes based on provider documentation.
• Identify and validate CMS-HCC and HHS-HCC conditions.
• Ensure coding accuracy, completeness, and compliance with CMS, HHS, and client-specific guidelines.
• Review medical records to identify missed coding opportunities and documentation gaps.
• Conduct coding validation and audit reviews as assigned.
• Maintain established productivity and quality standards.
• Collaborate with Quality Assurance teams to resolve coding discrepancies.
• Document coding rationale and support findings when required.
• Participate in coding calibrations, training sessions, and coding updates.
• Maintain current knowledge of ICD-10-CM, CMS-HCC, HHS-HCC, and Risk Adjustment regulatory changes.
• Adhere to HIPAA regulations and maintain confidentiality of protected health information (PHI).
• Utilize client-specific coding platforms and abstraction systems to complete chart reviews.

Required Qualifications

• Minimum 3–5 years of Risk Adjustment coding experience.
• Minimum 2 years of ACA Risk Adjustment coding experience preferred.
• Strong understanding of IVA ACA validation audits, ACA Risk Adjustment, and Medicare Advantage Risk Adjustment methodologies.
• Extensive knowledge of ICD-10-CM coding guidelines and documentation requirements.
• Experience reviewing electronic medical records and clinical documentation.
• Ability to work independently while maintaining high levels of accuracy and productivity.
• Strong analytical, organizational, and communication skills.

Required Certifications

Candidates must possess at least one of the following active certifications:

• CPC – Certified Professional Coder
• CCS – Certified Coding Specialist
• CRC – Certified Risk Adjustment Coder

Pay: $18.00 - $26.00 per hour

Benefits:

• Flexible schedule

Experience:

• Risk Adjustment Coding : 3 years (Required)

License/Certification:

• CRC, CPC or CCS Certification (Required)

Work Location: Remote