Risk Adjustment Coding Specialist I – QA Focus

Millennium Physician Group; Town of Florida (NY); On-site; USD 26,000 - 39,000; Full time

Job summary

Millennium Physician Group is seeking a Risk Adjustment Coding Specialist to support the Burden of Illness program. You will perform prospective reviews, validate diagnoses, and ensure accurate ICD-10-CM coding across encounters, with QA validation and collaboration with clinicians.

You will stay current with Medicare guidelines, participate in staff training, and help maintain high accuracy while meeting productivity targets in a fast-paced environment.

Qualifications

• Active coding credential (AAPC or AHIMA) required.
• 1 year medical field experience preferred, outpatient/ACO setting.
• Proficient in ICD-10-CM guidelines and conventions.
• Familiar with Medicare risk adjustment methodologies and HCC coding.
• Strong communication and analytical skills for documentation review.
• Ability to work independently and meet deadlines in a fast-paced environment.
• Proficiency in MS Office and multiple EMR systems.

Responsibilities

• Perform prospective medical record reviews for indicators supporting a diagnosis.
• Review encounter records and provider ICD-10-CM codes for accuracy before claim submission.
• Collaborate with providers to clarify documentation and ensure proper coding.
• Stay updated on Medicare guidelines, coding regulations, and reimbursement methods.
• Participate in coding education and training initiatives.
• Maintain a 95%+ accuracy rate and meet productivity standards.
• Abstract and assign ICD-10-CM codes from documentation in encounters.
• Conduct retrospective audits to identify discrepancies and opportunities.
• Analyze MRA data to identify patterns and interventions.
• Provide status reports and identify risks impacting project success.
• May take on additional projects or higher workload as assigned.

Skills

ICD-10-CM coding

Attention to detail

Analytical skills

Communication

Time management

Collaboration

Regulatory compliance

Education

High school diploma or GED

AAPC/AHIMA coding credential

CRC designation preferred

1 year medical coding experience

Tools

MS Office

EHR systems

Job description

Millennium Physician Group is seeking a Risk Adjustment Coding Specialist to support the Burden of Illness program. You will perform prospective reviews, validate diagnoses, and ensure accurate ICD-10-CM coding across encounters, with QA validation and collaboration with clinicians.

You will stay current with Medicare guidelines, participate in staff training, and help maintain high accuracy while meeting productivity targets in a fast-paced environment.