Remote Medicare Advantage Risk Adjustment Coder

Tier4 Group; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

Tier4 Group is seeking an Experienced Risk Adjustment Coder with Medicare Advantage and ACA coding expertise to support risk adjustment initiatives, medical record review, documentation validation, and QA activities. This role ensures CMS compliance and revenue integrity while working remotely under general supervision.

The candidate will review records, assign ICD-10-CM codes for MA/ACA programs, perform audits, and contribute to RADV activities.

Qualifications

• Minimum three (3) years of medical coding experience.
• Strong Medicare Advantage Risk Adjustment coding experience required.
• Experience with CMS-HCC coding methodologies and risk adjustment programs.
• Experience performing medical record reviews and coding validation activities.
• Ability to work independently in a remote environment while maintaining productivity and quality.
• CRC, CPC, CCS, RHIT, RHIA or similar coding certification preferred.

Responsibilities

• Review and assess medical record documentation and assign ICD-10-CM codes for Medicare Advantage and ACA Risk Adjustment.
• Perform retrospective and prospective coding reviews to identify supported HCC conditions.
• Evaluate medical records for coding accuracy, completeness, and CMS guidelines.
• Conduct quality assurance reviews and coding audits to ensure accuracy and compliance.
• Identify coding trends and provide feedback on documentation improvement opportunities.
• Support risk adjustment data validation, chart review, and audit initiatives.
• Collaborate with stakeholders to support risk adjustment and coding accuracy goals.
• Maintain productivity and quality standards while meeting deadlines.
• Assist with gap identification and closure initiatives for Medicare and ACA populations.
• Document coding results in designated systems and maintain accurate records.

Skills

Risk Adjustment

CMS-HCC

Medical Records

Documentation Validation

Quality Assurance

Remote Work

Attention to Detail

Communication

Tools

MS Office

EMR Systems

Job description

Tier4 Group is seeking an Experienced Risk Adjustment Coder with Medicare Advantage and ACA coding expertise to support risk adjustment initiatives, medical record review, documentation validation, and QA activities. This role ensures CMS compliance and revenue integrity while working remotely under general supervision.

The candidate will review records, assign ICD-10-CM codes for MA/ACA programs, perform audits, and contribute to RADV activities.