Risk Adjustment Coder (6 Months Fixed Term)

UST; Taguig; On-site; PHP 335,000 - 580,000; Full time

Job summary

UST in Taguig, Metro Manila, is seeking a Risk Adjustment HCC Coder to review and assign ICD-10-CM codes for Medicare Advantage and ACA Risk Adjustment projects. The role emphasizes accuracy, compliance, and timely coding.

Responsibilities include mapping diagnoses to HCC models, identifying documentation gaps, adhering to AHIMA standards, and maintaining 97%+ accuracy while meeting production targets. Night shift and onsite work required; remote options may be possible.

Qualifications

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

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 CDI opportunities for documentation discrepancies.
• Adhere to the Standards of Ethical Coding established by 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.

Skills

AAPC

Risk Adjustment Coding

ICD-10-CM

HIPAA

Tools

Coding software

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

• At least 6 months of 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 nightshift

• 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

Skills

AAPC, Risk Adjustment Coding, ICD-10-CM, HIPAA

Successful candidates will need to provide NBI, Former Employment docs among others