Medical Coder Risk Adjustment Only

Invent Health; Chennai District; Hybrid; INR 700,000 - 900,000; Full time

Job summary

A healthcare analytics company is seeking an experienced Risk Adjustment Medical Coder specialized in RADV audit validation to join the Chennai team. The ideal candidate will have 4–5 years of experience in Risk Adjustment Coding, with a strong understanding of the CMS-HCC model. Responsibilities include performing detailed chart reviews and ensuring compliance with CMS guidelines in a technology-enabled environment. This position offers a hybrid work model that integrates advanced AI/NLP tools for enhanced coding accuracy.

Qualifications

• 4–5 years of Risk Adjustment Coding experience, especially in Medicare Advantage.
• Hands-on RADV audit experience.
• Strong understanding of the CMS-HCC model (V24, V28 knowledge preferred).
• Familiarity with AI/NLP coding platforms.

Responsibilities

• Perform detailed chart reviews for Medicare Advantage (CMS-HCC V24 & V28).
• Conduct RADV-level validation and documentation review.
• Ensure adherence to CMS guidelines, ICD-10-CM Official Guidelines & MEAT criteria.
• Identify unsupported diagnoses and documentation gaps.

Skills

Risk Adjustment Coding

RADV audit experience

Analytical skills

ICD-10-CM Guidelines

CMS documentation standards

Education

Active certification: CRC / CPC / CCS

Tools

Coder Workbench

Job description

Medical Coder – Risk Adjustment (RADV Audit Specialist)

Chennai (Hybrid)

Experience: 4–5 Years

Invent Health Inc

Invent Health is a Silicon Valley–based healthcare analytics company focused on Risk Adjustment, Coding Intelligence, and NLP‑powered chart review solutions. We support leading U.S. health plans across Medicare Advantage, Medicaid, and ACA, processing over 5.5M+ member lives annually.

We are expanding our Chennai team and hiring an experienced Risk Adjustment Medical Coder with strong RADV audit expertise who is comfortable working in a technology‑enabled coding environment.

Role Overview

This role requires deep expertise in risk adjustment coding and RADV audit validation. You will work extensively on Invent Health’s proprietary NLP‑powered Coder Workbench, leveraging AI‑assisted insights while applying your clinical judgment to ensure CMS‑compliant, audit‑ready coding.

This is NOT a traditional manual coding role — we are looking for coders who can effectively use intelligent tools and maintain high accuracy under audit scrutiny.

Key Responsibilities

• Perform detailed chart reviews for Medicare Advantage (CMS‑HCC V24 & V28) and applicable LOB's.
• Conduct RADV‑level validation and documentation review
• Validate HCC capture, deletions, and documentation support
• Ensure adherence to CMS guidelines, ICD‑10‑CM Official Guidelines & MEAT criteria
• Work extensively within IH’s proprietary NLP‑enabled Coder Workbench
• Review and validate NLP‑suggested codes with high precision
• Identify unsupported diagnoses and documentation gaps
• Support internal QA and audit preparedness initiatives
• Analyze coding trends and contribute to quality improvement efforts
• Maintain strict HIPAA & PHI compliance

Required Qualifications

• 4–5 years of Risk Adjustment Coding experience (Medicare Advantage mandatory)
• Hands‑on RADV audit experience
• Strong understanding of CMS‑HCC model (V24; V28 knowledge preferred)
• Active certification: CRC / CPC / CCS (CRC preferred)
• Strong knowledge of:
  • RADV medical record validation
  • MEAT criteria
  • ICD‑10‑CM Official Guidelines
  • CMS documentation standards
• Comfortable working in AI/NLP‑assisted coding platforms
• Experience reviewing large medical records (100+ page charts)
• Strong analytical and documentation interpretation skills

Preferred

• Experience with technology‑enabled coding platforms or coder workbench tools
• Exposure to QA frameworks and second‑level audit reviews
• Experience supporting U.S. health plans
• Understanding of encounter data submission (837 exposure is a plus)