Risk Adjustment Coder

Reveleer; Chennai District; On-site; INR 600,000 - 900,000; Full time

Job summary

Reveleer is seeking an experienced Risk Adjustment Coder to review medical records, assign ICD-10-CM codes for HCC models, and ensure accuracy per CMS guidelines. The role requires CRC/CPC certification and a strong understanding of clinical terminology and documentation quality.

You will collaborate with QA and clinical teams to close coding gaps, maintain high productivity, and support audits and training initiatives while upholding HIPAA compliance in a fast-paced healthcare environment.

Qualifications

• Bachelor’s degree in Life Sciences, Nursing, Pharmacy, or related field.
• Minimum 2+ years of experience in Risk Adjustment / HCC Coding.
• CRC or CPC certification is mandatory.

Responsibilities

• Review medical records to assign accurate ICD-10-CM codes for HCC models.
• Ensure coding aligns with CMS risk adjustment guidelines and internal compliance.
• Validate documentation to support diagnoses and identify gaps.
• Collaborate with QA/clinical teams to resolve coding queries.
• Maintain productivity and accuracy as per organizational standards.
• Participate in audits, training, and continuous improvement.
• Identify trends and opportunities for documentation enhancement.
• Maintain HIPAA confidentiality and compliance.

Skills

ICD-10-CM

HCC mapping

Coding compliance

Attention to detail

EMR/EHR familiarity

Education

Bachelor’s degree in Life Sciences/Nursing/Pharmacy or related field

Tools

EMR/EHR systems

Job description

About the Role

We are seeking an experienced Risk Adjustment Coder with strong knowledge of HCC coding, CMS guidelines, RAF score calculation, and accurate clinical documentation review. The ideal candidate will be CRC/CPC certified and able to deliver high-quality coding with zero-compromise compliance standards.

Key Responsibilities

• Review and analyze medical records, charts, and documentation to assign accurate ICD-10-CM diagnosis codes for Risk Adjustment (HCC) models.
• Ensure coding accuracy that aligns with CMS, DX-HCC, and internal compliance guidelines.
• Validate clinical documentation to support submitted diagnoses and identify documentation gaps.
• Work closely with QA/clinical teams to resolve coding queries and discrepancies.
• Maintain productivity and accuracy standards as per organizational expectations.
• Participate in continuous audits, feedback sessions, and training programs to improve coding quality.
• Assist in identifying trends, risk areas, and opportunities for documentation improvement.
• Maintain confidentiality and compliance with HIPAA regulations.

Required Qualifications

• Bachelor’s degree Life Sciences, Nursing, Pharmacy, or related field.
• Minimum 2+ years of experience in Risk Adjustment / HCC Coding.
• CRC or CPC certification is mandatory.
• Strong understanding of CMS risk adjustment models, ICD-10 guidelines, and clinical terminology.

Skills & Competencies

• Excellent knowledge of ICD-10-CM, HCC mapping, and coding compliance.
• Strong analytical ability and attention to detail.
• Ability to interpret physician documentation accurately.
• Good communication and written skills.
• Familiarity with EMR/EHR systems and coding platforms.