HCC Risk Adjustment Specialist

Gonzaba Medical Group; San Antonio (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Gonzaba Medical Group in San Antonio, TX, is seeking a skilled Risk Adjustment Specialist to document acuity diagnoses for Medicare Advantage programs under capitated contracts.

You will review medical records, apply ICD-10-CM, CPT, HCPCS guidelines, and ensure supporting documentation meets MA payor requirements. This role emphasizes accuracy, compliance, and collaboration with physicians and staff to meet deadlines.

Qualifications

• Minimum high school education or equivalent required.
• Active Coding Certification by AHIMA or AAPC required.
• 3+ years' experience in Risk Adjustment (HCC) coding preferred.
• CPR with AED certification required.

Responsibilities

• Maintain compliance with Gonzaba policies and Official Coding Guidelines.
• Provide queries or guidance to physicians and staff to resolve coding issues.
• Accurately validate and abstract diagnosis codes to ensure ICD-10 documentation supports codes.
• Select ICD-10-CM, CPT and HCPCS codes based on documentation and guidelines.
• Assess notes for deficiencies and communicate elements to address for timely processing.
• Review Risk Adjustment audits for accuracy and data entry into the EMR.
• Assist with review activities to support Risk Adjustment and payer denial analysis.
• Complete electronic forms for submission of acuity diagnosis codes.

Skills

Risk Adjustment process

Medical terminology

HIPAA compliance

Education

AHIMA RHIA/RHIT/CCS/CCS-P or AAPC CPC/CRC

Tools

EMR systems

Job description

Gonzaba Medical Group in San Antonio, TX, is seeking a skilled Risk Adjustment Specialist to document acuity diagnoses for Medicare Advantage programs under capitated contracts.

You will review medical records, apply ICD-10-CM, CPT, HCPCS guidelines, and ensure supporting documentation meets MA payor requirements. This role emphasizes accuracy, compliance, and collaboration with physicians and staff to meet deadlines.