HCC Risk Adjustment Coder — ICD-10 Expert

Create Synergies Inc.; Taguig; On-site; PHP 360,000 - 600,000; Full time

Job summary

Create Synergies Inc. seeks a Risk Adjustment Coder to review medical records, assign accurate ICD-10-CM codes, and ensure proper HCC capture in line with CMS guidelines. You will validate documentation, uphold quality standards, and stay updated with regulatory changes.

The role requires 1–2 years in Risk Adjustment coding, knowledge of EHR systems, and the ability to work in a fast-paced BPO environment. CRC certification is highly preferred and experience with RADV audits is a plus.

Qualifications

• Bachelor's degree in nursing or allied health preferred.
• Active coding certification (CPC/CRC/CCS/CIC) or equivalent preferred (CRC highly preferred).
• 1–2 years of Risk Adjustment coding experience.
• Strong knowledge of ICD-10-CM guidelines and CMS-HCC methodology.
• Experience with EHR and coding software.

Responsibilities

• Review outpatient and physician medical records to identify and assign accurate ICD-10-CM diagnosis codes.
• Apply CMS-HCC Risk Adjustment guidelines and ensure proper HCC capture.
• Validate documentation for diagnoses accuracy and coding compliance.
• Maintain coding accuracy while meeting productivity and quality benchmarks.
• Stay current with ICD-10-CM, CMS-HCC, and regulatory updates.
• Participate in internal/external coding audits and implement corrective actions.

Skills

ICD-10-CM coding

CMS-HCC risk adjustment

Medical record review

Clinical documentation validation

Quality & compliance

Productivity management

Attention to detail

Critical thinking

Time management

Collaboration & communication

Education

Bachelor's degree in Nursing

Bachelor's degree in Medical Technology

Bachelor's degree in Pharmacy

Bachelor's degree in Allied health

Tools

EHR

Coding software

Job description

Create Synergies Inc. seeks a Risk Adjustment Coder to review medical records, assign accurate ICD-10-CM codes, and ensure proper HCC capture in line with CMS guidelines. You will validate documentation, uphold quality standards, and stay updated with regulatory changes.

The role requires 1–2 years in Risk Adjustment coding, knowledge of EHR systems, and the ability to work in a fast-paced BPO environment. CRC certification is highly preferred and experience with RADV audits is a plus.