Risk Adjustment Coder

UST; Taguig; On-site; PHP 300,000 - 500,000; 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 Risk Adjustment projects. The role emphasizes compliance with coding guidelines, documentation standards, quality metrics, and productivity targets.

Requirements include 6 months of medical coding experience (preferably HCC), an active coding certification (AAPC/AHIMA), and a college degree. Onsite work with possible remote arrangements is available.

Qualifications

• At least 6 months of Medical Coding experience, preferably in HCC Risk Adjustment.
• Active coding certification from AAPC or AHIMA.
• CRC certification preferred.

Responsibilities

• Assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment projects.
• Review medical records and map diagnoses to Risk Adjustment/HCC models.
• Identify and document CDI opportunities for documentation discrepancies.
• Follow AHIMA ethics and coding standards.
• Adhere to official ICD-10-CM guidelines and regulatory requirements.
• Ensure HIPAA compliance and data confidentiality.
• Maintain quality standards of 97%+ accuracy and meet production targets.
• Stay updated on coding updates and reimbursement reporting requirements.
• Participate in ongoing training and quality improvement initiatives.

Skills

ICD-10-CM coding

Attention to detail

Analytical skills

Independent work

Microsoft Office

Coding software

HIPAA knowledge

AHIMA/AAPC certification knowledge

Education

College degree

Tools

Coding software

Microsoft Office

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.

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

HIPAA, ICD-10-CM, AHIMA, AAPC