Risk-Adjustment Medical Coder - ICD-10-CM & HCC Expert

Insight Global; Tallahassee (FL); Remote; 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 to review medical records and assign ICD-10-CM codes that support risk adjustment and HCC reporting. Candidates should have strong medical record review experience and CMS guidelines familiarity to ensure evidence-based coding.

Ideal applicants will work with providers and clinical teams to improve coding accuracy and documentation quality, with emphasis on HCC reporting and regulatory compliance.

Qualifications

• Certified coder with CPC/CCS/CRC/CCA or equivalent
• 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 diagnosis codes
• Strong understanding of medical terminology, anatomy, physiology, and disease processes
• Ability to interpret complex clinical documentation with high accuracy and productivity
• Familiarity with 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

CPC/CCS/CRC/CCA

ICD-10-CM coding

Risk Adjustment

CMS guidelines

clinical documentation review

medical terminology

accuracy & productivity

Tools

EMRs

Coding software platforms

Job description

Insight Global is seeking Medical Coders specializing in Risk Adjustment to review medical records and assign ICD-10-CM codes that support risk adjustment and HCC reporting. Candidates should have strong medical record review experience and CMS guidelines familiarity to ensure evidence-based coding.

Ideal applicants will work with providers and clinical teams to improve coding accuracy and documentation quality, with emphasis on HCC reporting and regulatory compliance.