Risk Adjustment Coder (HCC) - CRC / CPC

Risk Adjustment Coder (HCC) - CRC / CPC

Company: Staffingly, Inc.Location: Hyderabad, India (work from office)

About the role

You will be reviewing patient charts for a US provider group and identifying risk adjustment gaps under the CMS-HCC model. This is prospective and concurrent review work, not retrospective chart chasing. You look at upcoming appointments, pull the two-year look-back history, and flag conditions the documentation supports but the provider has not captured.

The work is manual chart review. There is no NLP tool doing the first pass, so your clinical reading and coding judgment carry the whole job.

What you must have

• CRC certification (AAPC) preferred. CPC holders are welcome to apply if you have real risk adjustment experience.
• Minimum 2 years of hands-on HCC / risk adjustment coding. 3 years preferred. If you hold CPC only, the 2-year risk adjustment background is not negotiable.
• Working knowledge of CMS-HCC models and V28 mapping.
• Strong command of MEAT criteria (Monitor, Evaluate, Assess, Treat) and how to apply it to real progress notes.
• Current ICD-10-CM Official Guidelines knowledge. Familiarity with AHA Coding Clinic as a reference.
• Documented coding accuracy of 95% or better on your previous projects. Be ready to share your last quality scores.
• Comfort raising provider queries and writing them clearly enough that a physician can act on them.
• Willingness to work the night shift on a sustained basis.

Nice to have

• athenahealth (Athena) EMR experience, especially sending and tracking provider messages inside the platform.
• Experience in a health plan or ACO risk adjustment program.
• Exposure to provider education and documentation improvement feedback.
• End-to-end RCM understanding (how coding gaps turn into AR and reimbursement impact).

What you will do day to day

• Review scheduled and upcoming patient encounters and abstract HCC-relevant diagnoses supported by the documentation.
• Run the two-year look-back to present to locate open and unaddressed condition gaps.
• Apply MEAT to confirm each condition is genuinely supported before you code it. If it is not supported, you do not code it.
• Submit provider queries through the EMR when documentation is incomplete, and track responses.
• Flag patterns where providers are dismissing valid gaps or ignoring acknowledged ones, so the client can act on provider education.
• Keep your accuracy at or above 95% and take part in quality reviews and root cause discussions on errors.

Productivity expectations

StageTargetWeek 1 (training and ramp)10 to 15 patients reviewed per dayEnd of Week 225 patients reviewed per daySteady state25 patients per day minimum. 30 is the stretch goal.

Quality comes first. Hitting 30 charts with sloppy coding is a fail. Hitting 25 clean is a pass. Coders who consistently exceed target with strong quality are eligible for internal incentives.Role & responsibilities

Preferred candidate profile