Risk Adjustment HCC Coder

Mindlance; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in healthcare solutions is seeking a Quality Review and Audit Analyst for a 3-4 month fully remote assignment. The role involves conducting medical record reviews and ensuring compliance with coding guidelines. Ideal candidates must possess experience in Risk Adjustment and strong communication skills, having a background in medical documentation. Flexibility in work hours post-training and a detail-oriented approach are essential for success in this role.

Qualifications

• Candidates must have 2+ years of HCC/Risk Adjustment experience.
• Familiarity with CMS regulations for Risk Adjustment and coding compliance is required.
• Experience in remote work is preferred.

Responsibilities

• Conduct medical records reviews and code abstraction in accordance with guidelines.
• Perform documentation audits to identify gaps in risk-adjustment data.
• Communicate effectively across all audiences both written and verbally.

Skills

HCC/Risk Adjustment experience

Microsoft Office Experience

Excellent Written and Verbal communication skills

Experience with medical documentation audits

Proficiency with ICD-10-CM coding guidelines

Education

High school diploma

Coding Certifications by AHIMA or AAPC

Tools

Excel

MS Word

Adobe Acrobat

Job description

Get AI-powered advice on this job and more exclusive features.

This range is provided by Mindlance. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$27.00/hr - $28.50/hr

Direct message the job poster from Mindlance

Job Title : Quality Review and Audit Analyst

Duration : 3-4 Months Assignment

Locations : Fully Remote (WFH)

Schedule : Monday to Friday

Job Description:

Schedule Notes:

M-F: 9AM-5PM EST

Start time scheudle flexible after training, no earlier than 7AM EST and no later than 9AM EST (with consecutive 8-hour shift)

Responsibilities:

This position is 100% remote and candidates can be sourced from across the US as long as they're able to support the EST schedule.

Please list the candidate's location clearly on their resume.

Candidates must have a quiet and private working environment.

Candidates must have a reliable, high-speed internet connection.

Candidates cannot have any pre-planned/scheduled time off during the first 30 days of assignment.

Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, IFP Coding Guidelines and Best Practices, HHS Protocols, and any additional applicable rule set.

• Utilize HHS’ Risk Adjustment Model to confirm the accuracy of Hierarchical Condition Categories (HCC)identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.

• Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data capture, through the lens of HHS’ Risk Adjustment.

• Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk-adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners.

• Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners.

• Coordinate with stakeholders to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a timely manner.

• Communicate effectively across all audiences (verbal & written).

• Develop and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to Cigna IFP Coding Guideline updates and policy determinations, as needed.

Skills/Requirements:

TOP 3 NON-NEGOTIABLE SKILLS (OUTSIDE OF CERTIFICATION)

- HCC/Risk Adjustment experience (2 years+)

- Microsoft Office Experience

- Excellent Written and Verbal communication skills

• Experience with medical documentation audits and medical chart reviews, and proficiency with ICD-10-CM coding guidelines and conventions

• Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance, with both Inpatient and Outpatient documentation

• Computer competency with Excel, MS Word, Adobe Acrobat

• Must be detail-oriented, self-motivated, and have excellent organization skills

• Understanding of medical claims submissions is preferred

• Ability to meet timeline, productivity, and accuracy standards

• Experience working in a remote environment

• Excellent and clear written and verbal communication skills

Education:

The Quality Review & Audit Analyst will have a high school diploma and at least 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC):

• Certified Coding Specialist for Hospitals (CCS-H)

• Registered Health Information Technician (RHIT)

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Accounting/Auditing and Quality Assurance

• Industries

  Hospitals and Health Care and Insurance

Referrals increase your chances of interviewing at Mindlance by 2x

Get notified about new Medical Coder jobs in United States.

SDS/Observations Medical Coder - National Remote

SDS/Observations Medical Coder - National Remote

Clinical/Medical Coder - Evernorth - Remote

Medical Coder II/III (Emergency Department)

Boston, MA $75,000.00-$125,000.00 4 days ago

CERTIFIED OUTPATIENT MEDICAL CODER -- FULLY REMOTE (23348)

Medical Coder, CPC with ASC - US Full Time Remote Position

Medical Coder II/III (Surgery & Endoscopy)

Boston, MA $75,000.00-$125,000.00 4 days ago

Medical Coder 1 - Remote (See full posting for eligible states)

United States $40,000.00-$60,000.00 1 month ago

Mountlake Terrace, WA $51,000.00-$87,200.00 5 days ago

Medical Biller (DME) - Contract / Consultant

Medical Review Nurse Coder RN III (Payment Integrity Nurse)

California, United States $102,183.00-$163,492.00 3 weeks ago

Quality Assurance - Medical Coder - REMOTE - Digitech

United States $60,000.00-$75,000.00 1 week ago

CERTIFIED INPATIENT MEDICAL CODER -- FULLY REMOTE (23350)

CERTIFIED MEDICAL CODER AMBULATORY PROCEDURE VISIT (APV) -- FULLY REMOTE (23349)

Outpatient Medical Coder Edits - National Remote

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.