Risk Adjustment Coding Specialist

Trinity Health; Remote; USD 48,000 - 62,000; Full time

Job summary

A leading healthcare organization is hiring a Risk Adjustment Coder in Columbus, Ohio. This role involves reviewing medical records for accurate coding, ensuring compliance with best practices, and collaborating with healthcare providers. Candidates should have a High School Diploma, experience in medical coding, and relevant certifications like CPC. Offers competitive benefits including healthcare and tuition reimbursement. Join a team dedicated to compassionate care and inclusion.

Benefits

Competitive compensation

Medical, dental, and vision benefits

Generous paid time off

Tuition reimbursement

Retirement savings account with match

DailyPay option

Qualifications

• High School Diploma or Equivalent required.
• Active and up to date CPC certification preferred.
• Minimum of two years of experience in medical coding and billing required.
• Understanding of various medical claims formats.
• Working knowledge in medical terminology, CPT and ICD-10 coding.

Responsibilities

• Review and evaluate patient medical records for coding.
• Collaborate with providers to clarify documentation.
• Conduct retrospective coding reviews for missed HCCs.
• Provide feedback to clinical staff on documentation improvement.

Skills

Medical Coding

Documentation Validation

ICD-10 Coding

CPT Coding

Risk Adjustment Knowledge

Education

High School Diploma or Equivalent

CPC Certification

Certified Risk Adjustment Coder Certification

Job description

Employment Type: Full time

Shift:

Description

The Risk Adjustment Coder is responsible for reviewing and abstracting medical records to ensure accurate and complete diagnosis coding for risk adjustment purposes. This includes validating documentation using MEAT (Monitor, Evaluate, Assess, Treat) and TAMPER (Treatment, Assessment, Monitoring, Plan, Evaluation, Referral) principles to support Hierarchical Condition Category (HCC) coding. The coder also ensures accurate capture of Evaluation and Management (E/M) services and Current Procedural Terminology (CPT) codes to reflect the full scope of patient care and provider services. This role supports compliance, revenue integrity, and clinical documentation improvement through thorough review chart and collaboration with providers.

Position Purpose

The Risk Adjustment Coder is responsible for reviewing and abstracting medical records to ensure accurate and complete diagnosis coding for risk adjustment purposes. This includes validating documentation using MEAT (Monitor, Evaluate, Assess, Treat) and TAMPER (Treatment, Assessment, Monitoring, Plan, Evaluation, Referral) principles to support Hierarchical Condition Category (HCC) coding. The coder also ensures accurate capture of Evaluation and Management (E/M) services and Current Procedural Terminology (CPT) codes to reflect the full scope of patient care and provider services. This role supports compliance, revenue integrity, and clinical documentation improvement through thorough review chart and collaboration with providers.

What You Will Do

• Reviews and evaluates patient medical records to determine the level of Evaluation and Management (E/M) service, identify office non-E/M procedures, and diagnoses. Accurately assigns and sequences CPT, modifiers, and ICD-10 codes. Abstracts and validates information.
• Review patient medical records to identify and assign appropriate ICD-10-CM codes that map to HCCs.
• Ensure documentation meets MEAT and/or TAMPER criteria to support the presence and management of chronic conditions.
• Collaborate with providers to clarify documentation and educate on risk adjustment coding best practices.
• Conduct retrospective and prospective coding reviews to identify missed or undocumented HCCs.
• Maintain compliance with CMS, HHS, and payer-specific risk adjustment guidelines.
• Participate in internal audits and quality assurance processes to ensure coding accuracy.
• Provide feedback and training to clinical staff on documentation improvement opportunities.
• Stay current with updates to coding guidelines, risk adjustment models (e.g., CMS-HCC, HHS-HCC), and regulatory changes.
• Train and mentor peers and new coders on risk adjustment coding standards, MEAT/TAMPER documentation, and E/M/CPT capture.
• Responsible for compliance with Organizational Integrity through raising questions and promptly reporting actual or potential wrongdoing.
• All other duties as assigned.

Minimum Qualifications

• High School Diploma or Equivalent required
• Active and up to date CPC certification preferred
• Completes and submits Medicare Patient Assessment Forms and maintains accurate database of submission and payment.
• Certified Risk Adjustment Coder certification within one year of hire required.
• Minimum of two years of experience in medical coding and billing required.
• Understanding of various medical claims formats.
• Working knowledge in medical terminology, CPT and ICD-10 coding, and subsequent ICD versions.
• Expanded knowledge of Risk Adjustment and HCC coding.
• Knowledge of payer contracts and reimbursement.

Position Highlights and Benefits

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry / Facility Information

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free‑standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person‑centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran

EOE including disability/veteran