Remote Senior Risk Adjustment Coding Lead

Siho Insurance Group; Columbus (IN); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Siho Insurance Group is seeking a Senior Risk Adjustment Coding Specialist to provide expert coding guidance, mentor staff, and support audits to enhance risk-adjusted reimbursement programs. The role focuses on accurate retrospective, concurrent, and RADV reviews for Medicare Advantage, ACA, and related initiatives.

You will collaborate with providers and clinical teams to identify documentation gaps, drive education, and improve overall risk adjustment performance while maintaining HIPAA

Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree preferred.
• Minimum 5 years of medical coding experience.
• Minimum 3 years of dedicated risk adjustment coding experience.
• Demonstrated experience supporting audits, provider education, or coding quality initiatives.
• Advanced knowledge of CMS-HCC and risk adjustment methodologies.
• Strong knowledge of ICD-10-CM coding guidelines.
• Experience reviewing electronic medical records (EMRs).
• Proficiency with Microsoft Office applications.

Responsibilities

• Perform retrospective, concurrent, and RADV chart reviews to identify coding opportunities.
• Assign and validate ICD-10-CM codes based on documentation.
• Ensure CMS-HCC, HHS-HCC compliance.
• Maintain productivity and quality standards while meeting goals.
• Identify documentation gaps and communicate findings to providers and teams.
• Support provider education on risk adjustment documentation and coding.
• Participate in coding audits and validation activities.
• Research coding regulations and CMS guidance.
• Collaborate with quality, population health, and clinical operations teams.
• Track coding trends and recommend documentation improvements.
• Maintain HIPAA confidentiality.

Skills

Detail orientation

Analytical skills

Communication skills

Independent work

Education

High school diploma or GED

Associate's degree preferred

Bachelor's degree preferred

Tools

Epic

Athena

eClinicalWorks

Job description

Siho Insurance Group is seeking a Senior Risk Adjustment Coding Specialist to provide expert coding guidance, mentor staff, and support audits to enhance risk-adjusted reimbursement programs. The role focuses on accurate retrospective, concurrent, and RADV reviews for Medicare Advantage, ACA, and related initiatives.

You will collaborate with providers and clinical teams to identify documentation gaps, drive education, and improve overall risk adjustment performance while maintaining HIPAA