Associate II - Risk Adjustment HCC Medical Coder

UST; Taguig; On-site; PHP 279,000 - 446,400; Full time

Job summary

UST in the Philippines is seeking a Risk Adjustment Coder to accurately review and assign ICD-10-CM codes for Medicare Advantage and ACA Risk Adjustment projects. The role requires strict adherence to coding guidelines, HIPAA, and documentation standards while supporting compliant risk adjustment reimbursement.

You will review records, map diagnoses to HCC models, identify CDI opportunities, and maintain high accuracy (≥97%) and productivity.

Qualifications

• 6+ months experience in Medical Coding, preferably HCC.
• Active coding certification from AAPC or AHIMA.
• CRC certification preferred.
• Proficient in ICD-10-CM coding.
• Strong clinical knowledge of chronic disease diagnosis, treatment and management.
• Experience in BPO environment is a plus.

Responsibilities

• Assign ICD-10-CM codes for Medicare Advantage and ACA Risk Adjustment projects.
• Review medical records and map diagnoses to Risk Adjustment/HCC models.
• Identify flag events and CDI opportunities for documentation discrepancies.
• Adhere to AHIMA Standards of Ethical Coding.
• Follow official ICD-10-CM guidelines and regulatory requirements.
• Ensure HIPAA compliance and data confidentiality.
• Maintain quality/accuracy targets (≥97%) and productivity.
• Stay updated with coding updates and reimbursement requirements.
• Participate in ongoing training and quality initiatives.

Skills

Medical Coding

HCC Risk Adjustment

ICD-10-CM

Attention to detail

Independent worker

Education

College degree

Tools

Microsoft Office

Coding software

Job description

Role Description

The Risk Adjustment HCC Coder is responsible for accurately reviewing and assigning ICD-10-CM diagnosis codes that map to Medicare Advantage and ACA Commercial Risk Adjustment models. The role ensures compliance with coding guidelines, documentation standards, quality metrics, and productivity requirements while supporting accurate risk adjustment reimbursement.

Key Responsibilities

• Assign appropriate ICD-10-CM diagnosis codes for Medicare Advantage and ACA Commercial Risk Adjustment projects.
• Review medical records and accurately map diagnoses to applicable Risk Adjustment/HCC models.
• Identify and assign flag events and Clinical Documentation Improvement (CDI) opportunities for documentation discrepancies.
• Adhere to the Standards of Ethical Coding established by the American Health Information Management Association (AHIMA).
• Follow official ICD-10-CM coding guidelines and regulatory requirements.
• Ensure compliance with HIPAA laws, regulations, and confidentiality standards.
• Maintain established quality standards of 97% or higher accuracy and meet production targets.
• Stay current with coding updates, diagnosis guidelines, risk adjustment methodologies, and reimbursement reporting requirements.
• Participate in ongoing training and quality improvement initiatives.

Qualifications

• At least 6 months of experience in Medical Coding, preferably in HCC Risk Adjustment Coding.
• College degree
• At least 6 months of BPO experience.
• Active coding certification from AAPC or AHIMA.
• Certified Risk Adjustment Coder (CRC) certification is preferred.
• Proficient in coding using ICD-10-CM codebooks and/or coding software.
• Strong clinical knowledge of chronic disease diagnosis, treatment, and management.
• Computer proficiency, including Microsoft Office applications and internet-based tools.
• Strong attention to detail, analytical skills, and ability to work independently.

Work Requirements

• Must be willing to work onsite.
• Must be willing to work on a graveyard shift.
• Work-from-home arrangement may be available when warranted by business needs.
• Must have a reliable high-speed internet connection at home for remote work arrangements.

Preferred Skills

• Knowledge of Medicare Advantage and ACA Commercial Risk Adjustment programs.
• Familiarity with HCC coding methodologies and documentation standards.
• Strong communication and organizational skills.
• Ability to meet productivity and quality targets in a fast-paced environment.

Skills

AAPC, Risk Adjustment Coding, ICD-10-CM, HIPAA