Risk Adjustment Coding Specialist I

Mosaic Health, LLC.; Northern (KY); Hybrid; USD 30,000 - 45,000; Full time

Job summary

Mosaic Health, LLC. is seeking a healthcare coder to review medical records and validate diagnosis codes for risk adjustment. The role emphasizes documentation support, accuracy, and compliance within established guidelines under supervision.

The position requires an active coding credential (AAPC/AHIMA) and at least one year of related experience, with knowledge of ICD-10-CM and EHR systems. Salary ranges are provided and the company operates across the United States healthcare network.

Qualifications

• High school diploma or GED required.
• Active coding credential through AAPC or AHIMA required; CRC preferred.
• Minimum one year of healthcare, outpatient, coding, or related medical experience preferred.
• Working knowledge of ICD-10-CM coding conventions and medical terminology.
• Foundational understanding of anatomy, physiology, disease processes, and pharmacology.
• Familiarity with Medicare risk adjustment and HCC coding concepts preferred.
• Proficiency using electronic health record systems.

Responsibilities

• Review medical records to identify clinical documentation supporting diagnosis reporting and risk adjustment activities.
• Validate diagnosis codes selected by providers to ensure documentation supports accurate and compliant coding.
• Support prospective and concurrent coding review activities designed to improve diagnosis capture and documentation quality.
• Collaborate with providers and internal stakeholders to obtain clarification regarding documentation requirements.
• Maintain knowledge of ICD-10-CM coding guidelines, Medicare risk adjustment principles, and documentation requirements.
• Participate in coding education, training programs, and quality improvement initiatives.
• Meet established productivity and quality standards while maintaining coding accuracy.
• Protect the confidentiality and integrity of patient information in accordance with organizational policies and regulatory requirements.

Skills

Attention to detail

Analytical skills

Communication

Education

High school diploma or GED

Tools

Electronic health record systems

Job description

Job Description Summary

Summary Reviews medical records and supporting documentation to identify and validate diagnosis information used in risk adjustment coding. Applies established coding guidelines, payer requirements, and departmental procedures to routine records and refers documentation gaps or coding questions for review. Maintains accurate records of completed work and supports the timely capture of documented patient conditions. Work is performed under close supervision and follows established processes and procedures. Decisions are made within defined guidelines and escalated when issues fall outside standard protocols.

How will you make an impact & Requirements

• Review medical records to identify clinical documentation supporting diagnosis reporting and risk adjustment activities.
• Validate diagnosis codes selected by providers to ensure documentation supports accurate and compliant coding.
• Support prospective and concurrent coding review activities designed to improve diagnosis capture and documentation quality.
• Collaborate with providers and internal stakeholders to obtain clarification regarding documentation requirements.
• Maintain knowledge of ICD-10-CM coding guidelines, Medicare risk adjustment principles, and documentation requirements.
• Participate in coding education, training programs, and quality improvement initiatives.
• Meet established productivity and quality standards while maintaining coding accuracy.
• Protect the confidentiality and integrity of patient information in accordance with organizational policies and regulatory requirements.

Qualifications

• High school diploma or GED required
• Active coding credential through AAPC or AHIMA required; CRC preferred
• Minimum one year of healthcare, outpatient, coding, or related medical experience preferred
• Working knowledge of ICD-10-CM coding conventions and medical terminology
• Foundational understanding of anatomy, physiology, disease processes, and pharmacology
• Familiarity with Medicare risk adjustment and HCC coding concepts preferred
• Proficiency using electronic health record systems
• Strong attention to detail and analytical skills
• Ability to work within established procedures and prioritize assigned work
• Commitment to maintaining professional certification and ethical coding standards

Compensation Range

Compensation Range: $22.00 to $33.00

The anticipated base salary range represents the Company's good‑faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans.