Risk Adjustment Coder

Strategic Staffing Solutions, Inc.; Baton Rouge (LA); Remote; USD 65,000 - 85,000; Full time

Job summary

Strategic Staffing Solutions in Baton Rouge, LA seeks an experienced Risk Adjustment Coder with Medicare Advantage and ACA risk adjustment coding expertise. The role focuses on accurate ICD-10-CM coding, medical record reviews, documentation validation, and QA activities to support CMS compliance and revenue integrity.

This role can be performed remotely under general supervision. You will review records, identify coding gaps, collaborate with stakeholders, and ensure timely delivery of quality

Qualifications

• Minimum of 3 years of medical coding experience.
• Strong Medicare Advantage Risk Adjustment coding experience required.
• Experience with CMS-HCC coding methodologies and risk adjustment programs.
• Experience performing medical record reviews and coding validation activities.
• Ability to work independently in a remote environment while maintaining productivity and quality.

Responsibilities

• Review and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs.
• Perform coding reviews to identify supported HCC conditions.
• Evaluate records for coding accuracy, completeness, and CMS guidelines compliance.
• Conduct quality assurance reviews and coding audits.
• Document coding results in designated systems and maintain records.
• Collaborate with partners to support risk adjustment and coding accuracy goals.
• Maintain productivity and quality while meeting deadlines.

Skills

Medicare Advantage Risk Adjustment

CMS-HCC coding methodologies

Medical record review

Risk adjustment documentation validate

ICD-10-CM coding

Attention to detail

Analytical skills

Written and verbal communication

MS Office

EMR systems

Remote work experience

Education

High School Diploma or GED

Tools

Microsoft Office

EMR systems

Job description

Risk Adjustment Coder

Location: Baton Rouge, LA 70809
Contract Length: 4 Months

Position Summary

We are seeking an experienced Risk Adjustment Coder with a strong background in Medicare Advantage Risk Adjustment and ACA Risk Adjustment coding. This position supports ongoing risk adjustment initiatives through accurate coding, medical record review, documentation validation, and quality assurance activities.

The coder will help ensure compliance with CMS and other regulatory requirements while supporting risk adjustment accuracy and revenue integrity goals. Candidates should have demonstrated experience with CMS-HCC coding methodologies, medical record review, and risk adjustment documentation validation.

This position works under general supervision and does not have direct supervisory responsibilities.

Key Responsibilities

• Review and assess medical record documentation and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs.

• Perform retrospective and prospective coding reviews to identify supported HCC conditions.

• Evaluate medical records for coding accuracy, completeness, and compliance with CMS Risk Adjustment guidelines.

• Conduct quality assurance reviews and coding audits to ensure coding accuracy and regulatory compliance.

• Identify coding trends and provide feedback regarding documentation improvement opportunities.

• Support risk adjustment data validation, chart review, and audit initiatives.

• Collaborate with business partners and stakeholders to support risk adjustment and coding accuracy goals.

• Maintain productivity and quality standards while meeting established deadlines.

• Assist with gap identification and closure initiatives for Medicare and ACA populations.

• Document coding results in designated systems and maintain accurate records.

• Perform other duties as assigned.

Required Qualifications

Education

• High School Diploma or GED required.

Experience

• Minimum of 3 years of medical coding experience.

• Strong Medicare Advantage Risk Adjustment coding experience required.

• Experience with CMS-HCC coding methodologies and risk adjustment programs.

• Experience performing medical record reviews and coding validation activities.

• Experience interpreting clinical documentation and assigning accurate ICD-10-CM diagnosis codes.

• Ability to work independently in a remote environment while maintaining productivity and quality expectations.

Preferred Qualifications

• ACA Risk Adjustment coding experience.

• CRC, CPC, CCS, RHIT, RHIA, or similar coding certification.

• Experience conducting coding audits and quality assurance reviews.

• Experience supporting Risk Adjustment Data Validation (RADV) audits.

• Experience within a managed care, health insurance, or Medicare Advantage environment.

Knowledge, Skills, and Abilities

• Advanced knowledge of ICD-10-CM coding guidelines.

• Strong understanding of Medicare Advantage Risk Adjustment and HCC coding methodologies.

• Working knowledge of ACA Risk Adjustment principles.

• Strong analytical and problem-solving skills.

• Excellent attention to detail and organizational skills.

• Ability to interpret complex clinical documentation.

• Strong written and verbal communication skills.

• Intermediate proficiency with Microsoft Office applications.

• Experience working with Electronic Medical Record (EMR) systems.

• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.