Risk Adjustment Coder

Create Synergies Inc.; Philippines; On-site; PHP 420,000 - 640,000; Full time

Job summary

Create Synergies Inc. is seeking a Risk Adjustment Coder to review medical records and assign ICD-10-CM codes in line with CMS-HCC guidelines. You will validate documentation, ensure accurate risk capture, and maintain high coding quality and productivity.

Responsibilities include staying current with ICD-10-CM and CMS-HCC updates, participating in audits, and collaborating with CDI, QA, providers, and operations to resolve coding questions. HIPAA compliance is essential.

Qualifications

• Bachelor's degree or higher in Nursing, Medical Technology, Pharmacy, Physical Therapy, Occupational Therapy, or allied health-related field preferred.
• Active coding certification such as CPC, CRC, CCS, CIC or equivalent preferred (CRC highly preferred for Risk Adjustment).
• Minimum of 1–2 years of Risk Adjustment coding experience.
• Strong knowledge of ICD-10-CM coding guidelines, CMS-HCC methodology, and HCC categories.
• Experience with EHR systems and coding software.

Responsibilities

• Review outpatient and physician records to assign accurate ICD-10-CM codes.
• Apply CMS-HCC Risk Adjustment guidelines and ensure proper HCC capture.

Skills

ICD-10-CM Coding

CMS-HCC Risk Adjustment

Medical terminology

Documentation requirements

EHR & coding software

Analytical thinking

Attention to detail

Time management

Education

Nursing degree

Medical Technology degree

Pharmacy degree

Physical Therapy degree

Occupational Therapy degree

Allied health degree

Tools

CRC Certification

Job description

The Risk Adjustment Coder is responsible for reviewing and accurately assigning diagnosis codes to medical records in accordance with ICD-10-CM coding guidelines, CMS-HCC Risk Adjustment methodologies, and client-specific requirements. This role ensures complete and compliant documentation to support accurate risk score capture while maintaining high standards of coding quality, productivity, and regulatory compliance.

Key Responsibilities

• Review outpatient and physician medical records to identify and assign accurate ICD-10-CM diagnosis codes.
• Apply CMS-HCC Risk Adjustment coding guidelines and ensure proper Hierarchical Condition Category (HCC) capture.
• Validate medical documentation to ensure diagnoses are fully supported and compliant with coding standards.
• Maintain coding accuracy while meeting productivity and quality benchmarks.
• Stay current with annual ICD-10-CM, CMS-HCC, and regulatory guideline updates.
• Participate in internal and external coding audits and implement corrective actions when necessary.
• Collaborate with Quality Assurance, Clinical Documentation Improvement (CDI), providers, and Operations teams to resolve coding-related questions.
• Maintain confidentiality and comply with HIPAA, client policies, and company standards.
• Complete assigned coding tasks within required turnaround times.
• Participate in training, calibration sessions, and continuous improvement initiatives.

Qualifications

• Bachelor's degree in Nursing, Medical Technology, Pharmacy, Physical Therapy, Occupational Therapy, or any allied health-related course is preferred.
• Active coding certification such as CPC, CRC, CCS, CIC, or equivalent is preferred (CRC is highly preferred for Risk Adjustment coding).
• Minimum of 1–2 years of Risk Adjustment coding experience.
• Strong knowledge of:
• ICD-10-CM coding guidelines
• CMS-HCC Risk Adjustment methodology
• Hierarchical Condition Categories (HCC)
• Medical terminology, anatomy, physiology, and disease processes
• Documentation requirements for accurate diagnosis capture
• Experience working with Electronic Health Records (EHR) and coding software.
• Strong analytical, critical thinking, and problem-solving skills.
• Excellent attention to detail with the ability to consistently meet quality and productivity goals.
• Good written and verbal communication skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment.

Preferred Qualifications

• Certified Risk Adjustment Coder (CRC) credential.
• Experience with Medicare Advantage Risk Adjustment coding.
• Familiarity with RADV audits, provider education, and documentation improvement initiatives.
• Previous experience in a healthcare BPO or outsourcing environment is an advantage.

Key Competencies

• ICD-10-CM Coding
• CMS-HCC Risk Adjustment
• Medical Record Review
• Clinical Documentation ValidationQuality & Compliance
• Productivity Management
• Attention to Detail
• Critical Thinking
• Time Management
• Collaboration & Communication