Risk Adjustment Coder

Our Clients; Taguig; On-site; PHP 420,000 - 640,000; Full time

Job summary

Our Clients is seeking a Risk Adjustment Coder to review records and assign precise ICD-10-CM codes in line with CMS-HCC guidance. You will ensure documentation supports accurate risk scores while maintaining quality and regulatory compliance.

You will work with EHR systems and coding software, stay updated on coding changes, and collaborate with CDI and QA teams to resolve complex coding questions.

Qualifications

• Bachelor's degree in Nursing or allied health preferred.
• Active coding certification (CPC, CRC, CCS, CIC) or equivalent preferred.
• 1–2 years of Risk Adjustment coding experience.
• Strong knowledge of ICD-10-CM, CMS-HCC, and HCC concepts.
• Experience with EHR and coding software.
• Analytical, critical thinking and problem-solving skills.
• Attention to detail with ability to meet quality and productivity goals.
• Good written and verbal communication skills.
• Ability to work independently and manage multiple priorities.

Responsibilities

• Review outpatient and physician records to assign accurate ICD-10-CM codes.
• Apply CMS-HCC guidelines and ensure proper HCC capture.
• Validate documentation to ensure diagnoses are supported and compliant.
• Maintain accuracy while meeting productivity and quality benchmarks.
• Stay current with ICD-10-CM, CMS-HCC, and regulatory updates.
• Participate in coding audits and implement corrective actions as needed.
• Collaborate with QA, CDI, providers, and operations to resolve questions.
• Maintain confidentiality and HIPAA compliance.
• Complete assigned coding tasks within turnaround times.
• Participate in training, calibration, and continuous improvement.

Skills

Analytical thinking

Critical thinking

Problem solving

Attention to detail

Verbal communication

Written communication

Independent work

Multitasking

Education

Bachelor's degree in Nursing or allied health

Active coding certification (CPC/CRC/CCS/CIC) or equivalent

Tools

EHR systems

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