Risk Adjustment Coding Specialist II

verawholehealth; Town of Florida (NY); On-site; USD 32,000 - 47,000; Full time

Job summary

verawholehealth is seeking a Level II - Risk Adjustment Coding Specialist (Intermediate) to abstract ICD-10-CM codes from encounter documentation and audit medical records with minimal supervision. You will review VBAT actions and analyze MRA data to drive quality improvements and ensure accuracy and productivity benchmarks are met.

Minimum 2 years of coding experience (including 1 year HCC coding) and strong knowledge of ICD-10-CM conventions, medical terminology, and reimbursement systems are

Qualifications

• Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
• Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
• Extensive understanding of ICD-10-CM conventions, documentation standards, and reimbursement systems.
• Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
• Demonstrated ability to use a variety of electronic medical record systems.
• Ability to manage a significant workload and meet deadlines with minimal supervision.

Responsibilities

• Abstract and assign ICD-10-CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher-level coders.
• Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
• Perform comprehensive reviews of provider actions within the VBAT to identify outliers and improvement opportunities.
• Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
• Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
• Consistently meet or exceed accuracy and productivity benchmarks.
• May be assigned additional projects or a higher workload volume than a Level I specialist.

Skills

ICD-10-CM coding

Medical terminology

Documentation standards

MS Office

Time management

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

PowerPoint

EMR systems

Job description

Job Description Summary

Responsibilities

• Abstract and assign ICD 10 CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher level coders.
• Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
• Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
• Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
• Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
• Consistently meet or exceed accuracy and productivity benchmarks.
• May be assigned additional projects or a higher workload volume than a Level I specialist.

How will you make an impact & Requirements

LEVEL II - RISK ADJUSTMENT CODING SPECIALIST (Intermediate) (Includes all Level I responsibilities + the following)

Responsibilities

• Abstract and assign ICD‑10‑CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher‑level coders.
• Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
• Perform comprehensive reviews of provider actions within the Value‑Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
• Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
• Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
• Consistently meet or exceed accuracy and productivity benchmarks.
• May be assigned additional projects or a higher workload volume than a Level I specialist.

Qualifications

• Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
• Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
• Extensive understanding of ICD‑10‑CM conventions, documentation standards, and reimbursement systems.
• Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
• Demonstrated ability to use a variety of electronic medical record systems.
• Ability to manage a significant workload and meet deadlines with minimal supervision.

Compensation Range:

$22.99 to$34.49

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.