Risk-Adjustment Medical Coder – HCC & CMS Expert

Insight Global; Florida; On-site; USD 32,000 - 39,000; Full time

Benefits offered by this job

Healthcare insurance

Paid leave

Job summary

Insight Global is seeking Medical Coders specializing in Risk Adjustment Coding for a leading healthcare client. These professionals will review medical records and clinical documentation to accurately assign ICD-10-CM diagnosis codes that support risk adjustment and HCC reporting.

Ideal candidates will have strong experience with medical record review, coding compliance, and CMS guidelines, ensuring all diagnoses are fully supported by clinical evidence.

Qualifications

• Certified coder with CPC/CCS/CRC/CCA or equivalent certification.
• Strong ICD-10-CM coding experience and medical record review background.
• Knowledge of Risk Adjustment and HCC methodologies.
• Experience reviewing physician documentation and assigning accurate codes.
• Understanding of CMS guidelines and Medicare Advantage requirements.

Responsibilities

• Review medical records, physician documentation, and clinical data to identify reportable diagnoses.
• Assign accurate ICD-10-CM diagnosis codes based on coding guidelines and documentation.
• Identify diagnoses impacting Risk Adjustment and HCC reporting.
• Validate coded diagnoses against clinical evidence and documentation standards.
• Perform prospective and retrospective chart reviews.
• Identify missed, unsupported, or incorrectly coded diagnoses.
• Ensure compliance with CMS, Medicare Advantage, HIPAA, and organizational coding requirements.
• Participate in coding audits and quality assurance initiatives.
• Communicate coding and documentation questions with providers and clinical staff.
• Stay up to date on ICD-10, HCC, and CMS regulatory changes.

Skills

Certified coder

ICD-10-CM experience

Risk Adjustment knowledge

CMS guidelines knowledge

Physician documentation review

Medical terminology

Documentation interpretation

CMS regulatory updates

Tools

EMR systems

Coding software

Job description

Insight Global is seeking Medical Coders specializing in Risk Adjustment Coding for a leading healthcare client. These professionals will review medical records and clinical documentation to accurately assign ICD-10-CM diagnosis codes that support risk adjustment and HCC reporting.

Ideal candidates will have strong experience with medical record review, coding compliance, and CMS guidelines, ensuring all diagnoses are fully supported by clinical evidence.