Risk Adjustment Coder

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

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 Validation
• Quality & Compliance
• Productivity Management
• Attention to Detail
• Critical Thinking
• Time Management
• Collaboration & Communication