Risk Adjustment Coder - Data Quality & Compliance

DaMar Staffing; Virginia Beach (VA); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Tuition Assistance – $5,250/year

Paid Time Off

Bonus opportunities

Job summary

Sentara Health is seeking a Risk Coder to perform compliance activities focused on CMS and HHS risk adjustment. You will review provider coding, support RADV audits, and ensure accurate ICD-10-CM coding to capture appropriate HCCs.

The role requires an associate degree or equivalent coding experience, proficiency in ICD-10-CM, and CRC certification within two years. Experience with CMS/HHS RADV is preferred.

Qualifications

• Associate degree required in healthcare-related field with 2 years of medical coding experience (or 4 years without degree).
• Must know ICD-10-CM Official Coding Guidelines and AHA Coding Clinics.
• One-year prior experience with paper and/or electronic medical records.
• Must obtain CRC certification within two years of employment.
• Prefer CMS/HHS RADV experience and risk adjustment model familiarity.

Responsibilities

• Perform compliance activities focused on CMS/HHS risk adjustment.
• Conduct medical record reviews and RADV audits.
• Review provider coding to ensure CPT/ICD-10-CM alignment with CMS/HHS HCCs.
• Support RADV data validation, medical record retrieval, and vendor coding audits.
• Coordinate risk adjustment gap elimination with clinical and quality teams.
• Serve as SME on risk adjustment diagnosis coding guidelines.

Skills

Risk adjustment knowledge

Coding accuracy

HCC understanding

Education

Associate degree in Healthcare Administration, Nursing, HIM, Accounting or related field

1 year medical coding experience or 4 years if no degree

Certifications: CPC/COC/CIC/CCS-P/CCS/RHIT/RHIA; CRC within 2 years

Tools

ICD-10-CM Coding Guidelines

Job description

Sentara Health is seeking a Risk Coder to perform compliance activities focused on CMS and HHS risk adjustment. You will review provider coding, support RADV audits, and ensure accurate ICD-10-CM coding to capture appropriate HCCs.

The role requires an associate degree or equivalent coding experience, proficiency in ICD-10-CM, and CRC certification within two years. Experience with CMS/HHS RADV is preferred.