Risk Adjustment Coding Analyst

ASAS Health; Laredo (TX); On-site; USD 50,000 - 70,000; Full time

Job summary

A healthcare organization in Laredo, Texas is seeking a Certified Risk Adjustment Coding Analyst to optimize coding accuracy and ensure compliance with risk adjustment guidelines. The ideal candidate will have at least three years of experience in risk adjustment coding, hold relevant certifications, and possess strong analytical and communication skills. This full-time role involves collaborating with healthcare teams to enhance documentation and coding practices.

Qualifications

• Minimum of three years’ experience in risk adjustment coding.
• Strong knowledge of ICD-10-CM coding guidelines and CMS regulations.
• Experienced in conducting audits and validations for risk adjustment accuracy.

Responsibilities

• Accurately assign diagnostic codes (ICD-10-CM) from clinical documentation.
• Ensure coding adheres to official guidelines and payer policies.
• Conduct audits of medical records to verify code accuracy.

Skills

ICD-10-CM coding guidelines

HCC coding

CMS regulations

Analytical skills

Communication skills

Collaboration skills

Education

Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC)

Minimum of three years' experience in risk adjustment coding

Tools

EHR systems like Elation

EHR systems like Athena

AI applications like Ambiance

Job description

Overview

We are seeking a Certified Risk Adjustment Coding Analyst to support accurate medical coding and ensure compliance with risk adjustment guidelines. This role plays a vital part in optimizing coding accuracy for ASAS Health while supporting revenue integrity and regulatory compliance. The ideal candidate will have a strong background in medical coding, risk adjustment methodologies, and data validation processes.

ESSENTIAL FUNCTIONS

• Medical Coding: Accurately assign diagnostic codes (ICD-10-CM) from clinical documentation following risk adjustment guidelines (Medicare Advantage, Medicaid, ACA, etc.).
• Compliance & Accuracy: Ensure coding adheres to official coding guidelines, payer policies, and regulatory standards.
• Chart Reviews: Conduct audits of medical records to verify code accuracy, identify discrepancies, and support compliance efforts.
• Provider & Team Support: Collaborate with physicians, billers, coders, and clinician teams to enhance documentation and educate on risk adjustment best practices.
• Data Analysis: Monitor coding trends, conduct data validation, and generate reports to assess risk scores and financial impact.
• Continuous Learning: Stay up to date with regulatory changes, coding guidelines, and industry updates affecting risk adjustment coding. Always maintain active coding certification.

Education and Experience

• Minimum of three years’ experience in risk adjustment coding. Preferred five years of experience in health care coding.
• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent certification required.

Knowledge, Skills, and Abilities

• Strong knowledge of ICD-10-CM coding guidelines, HCC coding, and CMS regulations.
• Experience conducting audits and validations for risk adjustment accuracy.
• Excellent analytical skills with attention to detail in medical documentation.
• Strong communication and collaboration skills for provider education.
• Ability to handle multiple tasks with a high level of accuracy.
• Detail-oriented and organized.
• Strong work ethic.
• Experience with Medicare Advantage, Medicaid, or Affordable Care Act risk adjustment programs.
• Familiarity with EHR systems like Elation and Athena, and AI applications like Ambiance.
• Ability to interpret regulatory changes and apply them to coding practices.

Seniority level

• Associate

Employment type

• Full-time

Job function

• Analyst

Industries

• Hospitals and Health Care