HCC Risk Adjustment Coder (Onsite, Graveyard Shift)

UST; Taguig; On-site; PHP 350,000 - 550,000; Full time

Job summary

UST is seeking a Risk Adjustment HCC Coder to accurately review and assign ICD-10-CM codes for Medicare Advantage and ACA Commercial Risk Adjustment projects. The role emphasizes compliance with coding guidelines, documentation standards, quality metrics, and productivity targets.

You will review records, map diagnoses to HCC models, identify CDI opportunities, and stay current with risk adjustment methodologies and regulatory requirements.

Qualifications

• At least 6 months of experience in Medical Coding.
• At least 6 months of BPO experience.
• Active coding certification from AAPC or AHIMA.
• Certified Risk Adjustment Coder (CRC) certification is preferred.
• Proficient in ICD-10-CM codebooks and/or coding software.

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 and assign flag events and CDI opportunities for discrepancies.
• Adhere to AHIMA Standards of Ethical Coding.
• Follow official ICD-10-CM guidelines and regulatory requirements.
• Ensure HIPAA compliance and confidentiality.
• Maintain 97%+ accuracy and meet production targets.
• Stay current with coding updates and reimbursement reporting requirements.
• Participate in training and quality improvement initiatives.

Skills

Medical coding

HCC risk adjustment

BPO experience

Attention to detail

Analytical skills

Independent work

Education

AAPC or AHIMA certification

CRC certification (preferred)

Tools

ICD-10-CM codebooks

Coding software

MS Office

Job description

UST is seeking a Risk Adjustment HCC Coder to accurately review and assign ICD-10-CM codes for Medicare Advantage and ACA Commercial Risk Adjustment projects. The role emphasizes compliance with coding guidelines, documentation standards, quality metrics, and productivity targets.

You will review records, map diagnoses to HCC models, identify CDI opportunities, and stay current with risk adjustment methodologies and regulatory requirements.