Remote Risk Adjustment Quality Analyst

Talentify; Nashville (TN); Remote; USD 73,000 - 84,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Disability

Health Spending Account (HSA)

Transportation benefits

Time Off / PTO

Job summary

Aston Carter is seeking a Risk Adjustment Coding Oversight Specialist (Risk Analyst) for contract work in Nashville, TN. The role focuses on retrospective chart review, QA audits, and vendor oversight to ensure accurate Medicare Advantage risk adjustment coding.

Remote work is supported with standard business hours. You will lead quality assurance efforts, collaborate with internal teams and external vendors, and use AI-based coding tools to review and audit data.

Qualifications

• CPC or AHIMA CCS and CRC certifications required.
• Minimum 2+ years in medical record review, risk adjustment, coding, or quality auditing.
• Experience with AI-based coding software and vendor platforms.
• Knowledge of Medicare Advantage risk adjustment guidelines.

Responsibilities

• Conduct quality oversight audits of risk adjustment coding by internal and vendor coders.
• Perform retrospective chart reviews to validate diagnosis coding.
• Identify and adjust diagnoses based on chart review results.
• Document QA findings and report trends to leadership.
• Ensure vendor SLAs and quality standards are met.
• Collaborate with vendors and internal teams to resolve coding issues.
• Utilize AI-based tools to review and audit coded data.
• Participate in multiple risk adjustment projects concurrently.
• Contribute to continuous improvement of coding oversight processes.

Skills

CPC

AHIMA CCS

CRC

Medical record review

Risk adjustment knowledge

AI coding tools

Communication

Detail-oriented

Independent worker

Deadline-driven

Education

Associate’s degree

High school diploma or equivalent

Tools

AI coding tools

Vendor coding platforms

Job description

Aston Carter is seeking a Risk Adjustment Coding Oversight Specialist (Risk Analyst) for contract work in Nashville, TN. The role focuses on retrospective chart review, QA audits, and vendor oversight to ensure accurate Medicare Advantage risk adjustment coding.

Remote work is supported with standard business hours. You will lead quality assurance efforts, collaborate with internal teams and external vendors, and use AI-based coding tools to review and audit data.