Medical Coder - Risk Adjustment

Insight Global; United States; On-site; USD 28,000 - 39,000; Full time

Job summary

Insight Global is seeking Medical Coders specializing in Risk Adjustment to review records, assign ICD-10-CM codes for risk adjustment and HCC reporting. You will ensure documentation supports diagnoses and comply with CMS/HIPAA rules, with audits and provider collaboration. Medicare Advantage and HCC experience are valued.

Qualifications

• Certified coder (CPC, CCS, CRC, CCA, or equivalent)
• Strong ICD-10-CM coding experience and medical record review background
• Knowledge of Risk Adjustment and HCC coding methodologies
• Experience reviewing physician documentation and assigning accurate diagnosis codes
• Understanding of CMS guidelines, HIPAA, and Medicare Advantage requirements
• Ability to interpret complex clinical documentation with high accuracy and productivity

Responsibilities

• Review medical records and clinical data to identify reportable diagnoses
• Assign accurate ICD-10-CM codes based on guidelines and documentation
• Identify diagnoses impacting Risk Adjustment and HCC reporting
• Validate coded diagnoses against clinical evidence and documentation standards
• Perform prospective and retrospective chart reviews
• Identify missed or incorrectly coded diagnoses
• Ensure compliance with CMS, Medicare Advantage, HIPAA, and coding requirements
• Participate in coding audits and quality assurance initiatives
• Communicate coding questions with providers and clinical staff
• Stay up to date on ICD-10, HCC, and CMS regulatory changes

Skills

Certified coder

ICD-10-CM coding

Risk Adjustment / HCC

Medical record review

CMS guidelines

Documentation interpretation

Tools

EMR systems

Coding software

Job description

We are hiring Medical Coders who specialize in Risk Adjustment Coding to support a leading healthcare client. In this role, you will review medical records and clinical documentation to accurately assign ICD-10-CM diagnosis codes that support risk adjustment and HCC reporting.

Ideal candidates will have strong experience with medical record review, coding compliance, and CMS guidelines, ensuring all diagnoses are fully supported by clinical evidence. This role offers the opportunity to work closely with providers and healthcare teams to improve coding accuracy, enhance documentation quality, and support critical risk adjustment initiatives. Candidates with Medicare Advantage and HCC coding experience will be highly sought after.

Day-to-Day:

• Review medical records, physician documentation, and clinical data to identify reportable diagnoses
• Assign accurate ICD-10-CM diagnosis codes based on coding guidelines and documentation
• Identify diagnoses impacting Risk Adjustment and HCC reporting
• Validate coded diagnoses against clinical evidence and documentation standards
• Perform prospective and retrospective chart reviews
• Identify missed, unsupported, or incorrectly coded diagnoses
• Ensure compliance with CMS, Medicare Advantage, HIPAA, and organizational coding requirements
• Participate in coding audits and quality assurance initiatives
• Communicate coding and documentation questions with providers and clinical staff
• Stay up to date on ICD-10, HCC, and CMS regulatory changes

REQUIRED SKILLS AND EXPERIENCE

• Certified coder (CPC, CCS, CRC, CCA, or equivalent certification)
• Strong ICD-10-CM coding experience and medical record review background
• Knowledge of Risk Adjustment and HCC coding methodologies
• Experience reviewing physician documentation and assigning accurate diagnosis codes
• Strong understanding of medical terminology, anatomy, physiology, and disease processes
• Ability to interpret complex clinical documentation with high accuracy and productivity
• Familiarity with CMS guidelines and Medicare Advantage requirements

NICE TO HAVE SKILLS AND EXPERIENCE

• Medicare Advantage Risk Adjustment experience
• Experience working with CMS-HCC models
• Experience with EMRs and coding software platforms
• Background in a health plan, physician practice, hospital, or revenue cycle environment
• Audit and quality assurance experience

POSITION DETAILS:

• Pay: $20 - $28 per hour, depending on experience
• Location: MUST live in a state that is Eastern or Central Time