Risk Adjustment Coder & Auditor – HCC Specialist

Wakely Consulting Group; United States; On-site; USD 85,000 - 120,000; Full time

Job summary

Wakely Consulting Group seeks an experienced HCC Coder/Auditor to review, code, and audit medical records for risk adjustment reporting under CMS guidelines. You will communicate findings and improvement opportunities to clients and internal teams while maintaining audit-ready records.

Responsibilities include retrospective and prospective reviews for Medicare Advantage, education delivery, and ensuring compliance with ICD-10-CM guidelines.

Qualifications

• Minimum of a high school diploma or equivalent with CRC certification current.
• 5+ years medical coding experience, including HCC risk adjustment coding/auditing.
• Strong knowledge of ICD-10-CM guidelines and CMS risk adjustment.
• Experience with Medicare Advantage, RADV, retrospective/prospective reviews.

Responsibilities

• Review and code medical records for HCC risk adjustment.
• Perform coding audits and quality reviews to ensure accuracy.
• Identify undercoded/overcoded diagnoses and document rationale.
• Communicate findings and opportunities to clients and teams.
• Maintain audit-ready records and timekeeping in systems.
• Support education, quality improvement, and ongoing compliance.

Skills

ICD-10-CM coding

CMS Risk Adjustment

Auditing & QA

Communication skills

Education

High School Diploma

CRC Certification

CPC/CCS/RHIT/RHIA

Health information degree

Tools

EHR systems

Coding software

MS Office

Job description

Wakely Consulting Group seeks an experienced HCC Coder/Auditor to review, code, and audit medical records for risk adjustment reporting under CMS guidelines. You will communicate findings and improvement opportunities to clients and internal teams while maintaining audit-ready records.

Responsibilities include retrospective and prospective reviews for Medicare Advantage, education delivery, and ensuring compliance with ICD-10-CM guidelines.