Remote Risk Adjustment Coder — RAF/HCC Specialist

ADP, Inc.; Town of Florida (NY); Remote; USD 65,000 - 95,000; Full time

Job summary

ADP, Inc. is seeking a Risk Adjustment Coder to complete patient assessment forms via electronic systems and payer portals, and to support retrospective risk sweep processes with payers to enhance RAF accuracy and revenue integrity.

You will review medical records, submit required documentation within deadlines, resolve workflow exceptions, and collaborate with physicians and payer teams to ensure compliant coding under CMS ICD-10-CM guidelines and payer requirements.

Qualifications

• Knowledge of HCC models, risk adjustment principles, and compliant documentation and coding standards.
• Minimum 2 years of professional coding experience with risk adjustment, coding audit, medical-record review, or payer workflow experience preferred.
• CRC, CPC, CCS, or equivalent certification required within 18 months of hire.

Responsibilities

• Complete patient assessment forms accurately through electronic systems and payer portals.
• Manage payer portal queues and follow up on rejected or incomplete items.
• Support retrospective risk sweep processes and ensure timely documentation.
• Review medical records for diagnosis validation and coding accuracy under CMS/ICD-10-CM guidelines.
• Identify documentation gaps and opportunities for recapture and specificity.
• Maintain audit trails and submit forms with payer responses and follow-ups.
• Educate physicians and staff on risk adjustment documentation and coding expectations.

Skills

HCC methodologies

CMS-HCC

Payer portal systems

Medical-record review

Coding accuracy

Communication

Organization

Attention to detail

Safety and Security

Education

CRC/CPC/CCS or equivalent

Associate degree or coding program

Tools

Electronic health records (EHR) systems

Medical coding software

CMS guidelines

Job description

ADP, Inc. is seeking a Risk Adjustment Coder to complete patient assessment forms via electronic systems and payer portals, and to support retrospective risk sweep processes with payers to enhance RAF accuracy and revenue integrity.

You will review medical records, submit required documentation within deadlines, resolve workflow exceptions, and collaborate with physicians and payer teams to ensure compliant coding under CMS ICD-10-CM guidelines and payer requirements.