Risk Adjustment Coder

UST USource; Pateros; On-site; PHP 240,000 - 420,000; Full time

Job summary

UST USource is seeking a Risk Adjustment HCC Coder to accurately review and assign ICD-10-CM codes for MA and ACA risk adjustment projects.

Role requires onsite work with graveyard shifts; WFH may be available when business needs allow. You will review records, map diagnoses to HCC models, and strive for 97%+ accuracy while meeting productivity targets.

Qualifications

• At least 6 months of experience in Medical Coding, preferably HCC Risk Adjustment.
• Active coding certification from AAPC or AHIMA.
• CRC certification preferred.
• Proficient in ICD-10-CM codebooks and coding software.
• Strong clinical knowledge of chronic disease diagnosis, treatment, and management.
• Proficient with MS Office and internet-based tools.
• Strong attention to detail and ability to work independently.

Responsibilities

• Assign ICD-10-CM codes for Medicare Advantage and ACA Risk Adjustment projects.
• Review medical records and map diagnoses to HCC models.
• Identify flag events and CDI opportunities for documentation gaps.
• Adhere to AHIMA ethical coding standards.
• Follow ICD-10-CM guidelines and regulatory requirements.
• Ensure HIPAA compliance and confidentiality.
• Maintain 97%+ accuracy and meet production targets.
• Stay updated on coding changes and reimbursement reporting.
• Participate in ongoing training and quality initiatives.

Skills

Medical Coding

HCC Risk Adjustment

Attention to detail

Communication skills

Education

College degree

Tools

ICD-10-CM Codebooks

Coding Software

Microsoft Office

Job 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.