Senior Medical Coder- Risk Adjustment

DaMar Staffing; Tampa (FL); On-site; USD 65,000 - 95,000; Full time

Job summary

Insight Global is seeking a Senior Medical Coder specializing in Risk Adjustment coding to review clinical data and assign ICD-10-CM codes that support risk adjustment and HCC reporting.

The role requires meticulous chart review, strong coding compliance, and familiarity with CMS and Medicare Advantage rules. Collaboration with providers will enhance documentation quality and coding accuracy.

Qualifications

• Must hold a professional coding certification (CPC/ CCS/ CRC/ CCA or equivalent).
• Strong experience with ICD-10-CM coding and medical record review.
• Knowledge of Risk Adjustment and HCC coding methodologies required.
• Experience reviewing physician documentation and assigning accurate diagnosis codes.
• Solid understanding of medical terminology, anatomy, physiology, and disease processes.

Responsibilities

• Review medical records and clinical data to identify reportable diagnoses.
• Assign ICD-10-CM codes based on documentation and coding guidelines.
• Identify diagnoses impacting Risk Adjustment and HCC reporting.
• Validate codes against clinical evidence and documentation standards.
• Perform prospective and retrospective chart reviews to improve accuracy.
• Identify missed or incorrectly coded diagnoses and communicate findings.
• Ensure CMS, Medicare Advantage, HIPAA, and internal coding requirements are met.
• Participate in coding audits and quality assurance initiatives.
• Collaborate with providers and clinical staff to clarify documentation.
• Keep up to date with ICD-10, HCC, and CMS regulatory changes.

Skills

Certified coder (CPC/ CCS/ CRC/ CCA)

ICD-10-CM coding

Risk Adjustment & HCC coding

Medical record review

Clinical terminology & anatomy

CMS guidelines

Documentation interpretation

Tools

EMRs

Coding software platforms

Job description

Senior Medical Coder Specializing in Risk Adjustment Coding

Required Skills & Experience:

• Certified coder (CPC, CCS, CRC, CCA, or equivalent certification)
• Strong ICD-10-CM coding experience and medical record review background
• Knowledge of Risk Adjustment and HCC coding 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

Nice to Have Skills & Experience:

• Medicare Advantage Risk Adjustment experience
• Experience working with CMS-HCC models
• CRC (Certified Risk Adjustment Coder) certification
• Experience with EMRs and coding software platforms
• Background in a health plan, physician practice, hospital, or revenue cycle environment
• Audit and quality assurance experience

Job Description:

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

The ideal candidate will have strong experience with medical record review, coding compliance, and CMS guidelines, ensuring all diagnoses are fully supported by clinical evidence. This role offers the opportunity to work closely with providers and healthcare teams to improve coding accuracy, enhance documentation quality, and support critical risk adjustment initiatives. Candidates with Medicare Advantage and HCC coding experience will be highly sought after.

Day-to-Day:

• 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