Risk Adjustment Coder

Sentara Healthcare Inc; Virginia Beach (VA); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Sentara Medical Group in Virginia Beach, VA is seeking a full-time hybrid Risk Adjustment Coder to ensure accurate CMS/HHS risk adjustment documentation. The role blends remote and in-office work, with 1-2 days on site weekly and travel as needed to support team objectives.

The position requires 1 year Medical Records Data experience and 2 years Coding experience, plus certification options including CPC/COC/CIC etc.

Qualifications

• Associate degree is required.
• 1 year Medical Records Data experience is required.
• 2 years Coding experience is required.
• Certifications CPC/COC/CIC/CCS-P/CCS/RHIT/RHIA are accepted; CRC certification within 2 years is required.

Responsibilities

• Performs compliance activities focused on CMS/HHS risk adjustment.
• Reviews provider coding for professional and inpatient/outpatient services to ensure CMS/HCC capture.
• Supports RADV audits, data validation, and vendor coding quality.
• Coordinates risk adjustment gap elimination with clinical and quality teams.

Skills

Medical Records Data

Coding

Risk Adjustment Coding

Education

Associate degree (Required)

Certified Professional Coder (CPC)

Certified Outpatient Coder (COC)

Certified Inpatient Coder (CIC)

Certified Coding Specialist-Physician-based (CCS-P)

Certified Coding Specialist (CCS)

Registered Health Information Technician (RHIT)

Registered Health Information Administrator (RHIA)

Certified Risk Adjustment Coder (CRC)

Job description

Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA!

Hours: Monday - Friday, 8:00AM -5:00PM, dayshift.

This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week. The role also includes travel as needed to support business objectives and team collaboration.

Overview

Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training, monitoring, & auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. Performs vendor quality oversight audits; reviews and/or makes final coding determination for non-agreeable coding. Makes final decision on vendor-to-vendor diagnosis coding rebuttal concerns. Serves as subject matter expert on risk adjustment diagnosis coding guidelines. Coordinates risk adjustment gap elimination with clinical and quality gap elimination Maintains a reasonable fluency in workings & financial implications of applicable risk adjustment models.

Education

• Associate degree (Required)

Experience

• Medical Records Data - 1 year (Required)
• Coding - 2 years (Required)

Certifications:

One of the following certifications are required: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist-Physician-based (CCS-P), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

Must obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment.

Keywords:

Risk Adjustment Coding & Documentation Specialist, Talroo-Allied Health, Medical Office