Risk Adjustment Coder III

Cano Health LLC; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Cano Health LLC is seeking a Risk Adjustment Coder III to ensure accurate ICD-10-CM coding and timely chart reviews in support of risk adjustment models. The role emphasizes adherence to guidelines, audit readiness, and collaboration with clinical teams.

Candidates should have CPC/CCS certifications and at least 5 years of medical coding experience with risk adjustment, working within established policies to maintain data integrity and regulatory compliance.

Qualifications

• 5 years of medical coding experience with focus on risk adjustment or HCC.
• Excellent knowledge of ICD-10-CM coding conventions and guidelines.
• Strong analytical skills with attention to detail.
• Ability to review and interpret medical records and clinical documentation.

Responsibilities

• Assign ICD-10-CM diagnosis codes based on medical records following guidelines.
• Perform detailed chart reviews to ensure accurate capture of diagnoses including HCC codes.
• Identify and correct coding discrepancies based on documented evidence.
• Apply CMS-HCC and other risk adjustment guidelines in daily work activities.
• Participate in routine coding audits and apply feedback to improve accuracy.
• Collaborate with coding team, clinical documentation staff, and leadership to resolve issues.
• Maintain knowledge of ICD-10-CM updates and risk adjustment guidelines.

Skills

Analytical skills

Attention to detail

Communication skills

Independent work

Auditing experience

Education

Associate degree or certification in Health Information Management

Certified Professional Coder (CPC)

Certified Coding Specialist (CCS)

Certified Risk Adjustment Coder (CRC) preferred

5 years medical coding experience with risk adjustment

Job description

Job Summary

The Risk Adjustment Coder III is responsible for the accurate and timely assignment of medical diagnosis codes in accordance with established risk adjustment models, coding guidelines, and organizational standards.

This role performs high-volume, production-based coding and chart review activities, following defined policies and procedures to ensure compliance and data accuracy.

This position applies advanced coding knowledge but operates within established guidelines, with work subject to quality review and audit.

Duties & Responsibilities

Essential Duties & Responsibilities

Medical Coding and Documentation

Assign ICD-10-CM diagnosis codes based on medical records, clinical documentation, and encounter data in accordance with established coding guidelines.

Perform detailed chart reviews to ensure accurate capture of diagnoses, including HCC codes, following risk adjustment requirements.

Identify and correct coding discrepancies based on documented evidence and coding standards.

Maintain required productivity and quality benchmarks for coding volume and accuracy.

Risk Adjustment Compliance

Apply CMS-HCC and other risk adjustment coding guidelines in daily work activities.

Follow established compliance protocols to ensure coding meets regulatory and internal standards.

Participate in routine coding audits and apply feedback to improve accuracy and consistency.

Data Quality & Accuracy

Ensure all assigned codes are supported by appropriate clinical documentation.

Track and report coding errors or inconsistencies to leadership.

Maintain accuracy standards as defined by departmental performance metrics.

Collaboration and Support

Work collaboratively with coding team members, clinical documentation staff, and leadership to resolve coding issues.

Provide guidance and support to junior coders as directed by leadership.

Participate in team meetings, training sessions, and workflow discussions.

Education and Development

Maintain current knowledge of ICD-10-CM coding updates and risk adjustment guidelines.

Complete required training and continuing education to maintain certifications.

Apply updates and changes to coding practices as directed.

Supervisory Responsibilities

Work is performed under general supervision with clearly defined procedures and guidelines.

Exercises judgment within established coding standards; does not set policy or interpret regulations independently.

Work is regularly reviewed for accuracy, quality, and productivity.

Education & Experience

• High school diploma or equivalent.
• Associate’s degree or certification in Health Information Management, Medical Coding, or related field is preferred.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.
• Certified Risk Adjustment Coder (CRC) preferred.
• 5 years of experience in medical coding with a focus on risk adjustment or HCC coding.
• Extensive knowledge of ICD-10-CM coding guidelines and risk adjustment methodologies.
• Experience with medical record review, documentation guidelines, and auditing.

Education Requirements

Required/Preferred Education Level Discipline Required High School Diploma Required Certification Certified Professional Coder (CPC) Required Certification Certified Coding Specialist (CCS) Preferred Certification Certified Risk Adjustment Coder (CRC) Knowledge, Skills & Proficiencies Five (5) years prior medical coding experience (ICD-10, CPT, and HCPCS). Expertise of Medicare Risk Adjustment methodology. Additional AAPC specialty certifications (CPMA, CDEO, etc.). Excellent knowledge of ICD-10-CM coding conventions and guidelines. Excellent communication skills, both written and verbal, for engaging with clinical teams, physicians, and management. Strong analytical skills with attention to detail. Ability to review and interpret medical records and clinical documentation effectively. Ability to work independently and prioritize tasks in a fast-paced environment. Demonstrated critical thinking and decision-making skills relative to clinical documentation. Experience with medical record review and documentation auditing.

Physical Requirements

• This position works under usual office conditions.
• The associate is required to work at a personal computer as well as be on the phone for extended periods of time.
• Must be able to stand, sit, walk and occasionally climb.
• The incumbent must be able to work extended and flexible hours and weekends as needed.
• Physical demands include ability to lift up to 50 lbs.
• The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing.

Travel Requirements

Amount of Expected Travel Details Required 0-25% Flexibility to travel to clinical sites as needed.

Tools & Equipment Used

• Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time.

Equal Opportunity

Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

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