Hybrid Risk Adjustment Coder - CMS/HHS Expert

143 Sentara Healthcare; United States; Hybrid; USD 71,000 - 109,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

401k with employer match

Tuition assistance

Student debt payoff

Job summary

Sentara Health is seeking a Risk Adjustment Coder for a full-time hybrid role in Virginia Beach, VA. The position blends remote and onsite work with 1–2 in-office days weekly and potential site visits.

Responsibilities include CMS/HHS risk adjustment coding, MMR and RADV audits, and reviewing professional and inpatient/outpatient claims to capture diagnoses. Requires Associate degree and 2 years coding experience plus CPC/COC/CIC certifications and CRC within 2 years.

Qualifications

• Associate degree is required.
• Medical Records Data experience: 1 year required.
• Coding experience: 2 years required.
• Must obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment.

Responsibilities

• Performs compliance activities focused on risk adjustment in accordance with CMS and HHS.
• Performs prospective/retrospective medical record reviews and RADV audits.
• Reviews provider coding for professional and inpatient/outpatient services to ensure capture of diagnostic conditions.
• Supports risk adjustment data validation, medical record retrieval, vendor coding audits, and provider engagement.
• Conducts annual risk assessments, training, monitoring, and auditing, and corrective action oversight.

Education

Associate degree

Job description

Sentara Health is seeking a Risk Adjustment Coder for a full-time hybrid role in Virginia Beach, VA. The position blends remote and onsite work with 1–2 in-office days weekly and potential site visits.

Responsibilities include CMS/HHS risk adjustment coding, MMR and RADV audits, and reviewing professional and inpatient/outpatient claims to capture diagnoses. Requires Associate degree and 2 years coding experience plus CPC/COC/CIC certifications and CRC within 2 years.