Remote Risk Adjustment Medical Coder (HCC/CMS)

Jobrapido; Boston (MA); Remote; USD 32,000 - 39,000; Full time

Benefits offered by this job

Healthcare insurance offerings

Paid leave as provided by applicable法

Competitive compensation

Job summary

Insight Global is seeking Medical Coders specializing in Risk Adjustment Coding to support a leading healthcare client. You will review medical records and clinical documentation to assign ICD-10-CM codes that support risk adjustment and HCC reporting.

Ideal candidates have strong medical record review, coding compliance, and CMS guideline experience, collaborating with providers to improve documentation quality and coding accuracy. Medicare Advantage and HCC coding experience are highly valued.

Qualifications

• Certified coder with 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.
• Solid medical terminology, anatomy, physiology and disease process knowledge.
• Ability to interpret complex clinical documentation with high accuracy and productivity.
• Familiarity with CMS guidelines and Medicare Advantage requirements.

Responsibilities

• Review medical records, physician documentation, and clinical data to identify reportable diagnoses.
• Assign accurate ICD-10-CM diagnosis 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, 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.

Skills

Certified coder

ICD-10-CM coding

Risk Adjustment

HCC coding

Physician documentation review

Medical terminology

Clinical documentation interpretation

CMS guidelines

Medicare Advantage

CMS guidelines knowledge

Education

CRC certification

Tools

EMRs

Coding software platforms

Job description

Insight Global is seeking Medical Coders specializing in Risk Adjustment Coding to support a leading healthcare client. You will review medical records and clinical documentation to assign ICD-10-CM codes that support risk adjustment and HCC reporting.

Ideal candidates have strong medical record review, coding compliance, and CMS guideline experience, collaborating with providers to improve documentation quality and coding accuracy. Medicare Advantage and HCC coding experience are highly valued.