Risk Adjustment Coder - Remote

Shelby American, Inc.; Culver City (CA); Remote; USD 70,000 - 100,000; Full time

Job summary

A leading healthcare organization is seeking a CMS HCC/Risk Validation Audit coder for a flexible, seasonal project. This full-time role offers opportunities for continued work, focused on data validation, diagnosis confirmation, and utilizing risk adjustment coding knowledge. Candidates must have substantial experience and active AAPC or AHIMA certification.

Qualifications

• Minimum 5 years verifiable risk adjustment coding experience post certification.
• Must maintain a 95% accuracy rate and 3 CPH.

Responsibilities

• Review member and claim data validation aspects.
• Confirm risk-adjusting diagnoses and report valid omissions.
• Identify acceptable provider specialty.

Skills

Knowledge of ICD-10-CM IP and OP coding

Risk adjustment coding

Data validation

Education

Active certification through AAPC or AHIMA

Job description

This is a flexible CMS HCC/Risk Validation Audit role for a seasonal project. Other opportunities for continued work may be available at the conclusion of the project. Full time opportunities are available at either 30 or 40 hours weekly.

Flexible work hours - nights and weekends are acceptable.

• Coders will review member and claim data validation aspects, which include: Member name, Member DOB, Gender, Dates of service, claim type, and provider signature
• Coders will be presented with all risk-adjusting diagnoses billed on a claim for a particular date of service or inpatient stay
• Must be able to identify acceptable provider specialty
• Coder must have knowledge of ICD-10-CM IP and OP coding
• Coders will confirm or not confirm each diagnosis
• Coders will add risk-adjusting diagnoses that are valid but not reported

Requirements

• Active certification through AAPC or AHIMA is required
• Minimum 5 years verifiable risk adjustment coding experience post certification
• Must be able to maintain a 95% accuracy rate and 3 CPH