Remote Risk Adjustment Specialist

Remote Co.; United States; Remote; USD 72,000 - 90,000; Full time

Job summary

Tufts Medicine is seeking a Risk Adjustment Consultant to review Medicare, Medicaid, and Commercial HCCs through medical record reviews. The role requires CRC certification (or within 12 months) and 2 years of outpatient billing, coding, and risk adjustment experience.

Remote, full-time with standard hours. The position involves audits, coding accuracy reviews, and education for physicians to ensure CMS and DxCG guideline compliance.

Qualifications

• CRC certification or must obtain within first 12 months of employment.
• Two years of outpatient billing, coding, and risk adjustment experience.

Responsibilities

• Performs ongoing audit of medical records for our LCO groups and network providers to ensure diagnosis and CPT coding accuracy.
• Performs medical record audits to determine coding accuracy to CMS and DxCG regulations and guidelines.
• Evaluates medical records for authorized providers, face-to-face CPT codes, and signatures; adheres to technical requirements.
• Summarizes audit findings for leadership; tracks results, identifies trends, and recommends corrective actions.
• Provides coding education to physicians on Risk Adjustment guidelines and CMS regulations.

Skills

CRC Certification

Outpatient billing experience

Risk adjustment coding

Education

Associate's degree

Job description

Tufts Medicine is seeking a Risk Adjustment Consultant to review Medicare, Medicaid, and Commercial HCCs through medical record reviews. The role requires CRC certification (or within 12 months) and 2 years of outpatient billing, coding, and risk adjustment experience.

Remote, full-time with standard hours. The position involves audits, coding accuracy reviews, and education for physicians to ensure CMS and DxCG guideline compliance.