Risk Adjustment Coder

ClinDCast LLC; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

ClinDCast LLC is seeking an experienced Risk Adjustment Coder to perform medical record reviews, coding validation, and audits in line with CMS guidelines. The role requires strong ICD-10-CM knowledge, risk adjustment methodologies, and regulatory compliance expertise.

The position is remote, offering collaboration with internal teams to resolve discrepancies and support audit requirements while meeting productivity and quality targets. Certification in risk-adjusted coding is preferred.

Qualifications

• Experience with ICD-10-CM coding and risk adjustment methodologies.
• Knowledge of CMS risk adjustment guidelines and regulatory requirements.
• Ability to identify documentation gaps and coding discrepancies.
• Ability to meet productivity and quality targets.

Responsibilities

• Review medical records to identify and validate reportable diagnoses.
• Perform first-pass and second-pass coding reviews and audits.
• Ensure accurate ICD-10-CM code assignments per CMS requirements.
• Verify diagnoses are supported by documentation.
• Identify coding discrepancies and compliance issues.
• Maintain audit docs and record findings and recommendations.
• Follow coding guidelines and quality protocols.
• Meet productivity, accuracy, and quality targets.
• Collaborate with teams to resolve discrepancies and support audits.

Skills

ICD-10-CM coding

CMS guidelines knowledge

Medical records review

Audit skills

Job description

Job Description: Risk Adjustment Coder

Job Summary

We are seeking an experienced and certified Risk Adjustment Coder to perform medical record reviews, coding validation, and audit activities in accordance with applicable CMS guidelines. The ideal candidate will have strong knowledge of ICD-10-CM coding, risk adjustment methodologies, medical record documentation, and regulatory compliance requirements.

Key Responsibilities

• Review medical records to identify and validate reportable diagnoses.
• Perform first-pass and second-pass coding reviews and audits, as applicable.
• Ensure accurate diagnosis code assignment in accordance with ICD-10-CM guidelines and CMS requirements.
• Verify that coded diagnoses are supported by appropriate medical record documentation.
• Identify coding discrepancies, documentation gaps, and potential compliance issues.
• Maintain accurate audit documentation and record findings, errors, and recommendations.
• Follow established coding guidelines, quality standards, and compliance protocols.
• Meet productivity, accuracy, and quality performance targets.
• Collaborate with internal teams to resolve coding discrepancies and support audit requirements.

This is a remote position.