Senior Risk Adjustment Coder II — HCC & CMS Specialist

Harris Health; Houston (TX); On-site; USD 70,000 - 100,000; Full time

Job summary

Community Health Choice, Inc., affiliated with Harris Health System, seeks a Risk Adjustment Coder II to review complex medical records and map diagnoses to HCCs per CMS guidelines. The role supports Commercial and Medicare risk adjustment efforts and requires expert coding skills.

The ideal candidate has 3–5 years in risk adjustment coding, AHIMA/AAPC certification, and a strong grasp of documentation improvement within a managed care environment.

Qualifications

• Bachelor's Degree or 5+ years of risk adjustment experience required.
• AHIMA/AAPC Certified Coder (CPC/CRC/COC/CCS/CCS-P) required.
• 3-5 years' experience in Commercial or Medicare risk adjustment coding.
• Education: Associate or bachelor's degree preferred.
• Experience in a managed care organization preferred.

Responsibilities

• Provide advanced complex medical records reviews to identify and code all relevant diagnoses.
• Code all conditions using ICD-10 guidelines for risk adjustment programs.
• Review documentation to ensure adequate support and accuracy for coded conditions.
• Suggest improvements to leadership to enhance documentation and coding quality.
• Maintain productivity and quality standards per supervisor guidance.

Skills

Strong analytical skills

Strong written and verbal skills

Strong interpersonal skills

ACA knowledge

Medicaid and Medicare Risk Adjustment

Education

Bachelor's degree or 5+ years risk adjustment experience

AHIMA/AAPC Certified Coder (CPC/CRC/COC/CCS/CCS-P)

Associate or Bachelor's degree preferred

Tools

Microsoft 365 (Word, Excel, Outlook, SharePoint, Teams)

Job description

Community Health Choice, Inc., affiliated with Harris Health System, seeks a Risk Adjustment Coder II to review complex medical records and map diagnoses to HCCs per CMS guidelines. The role supports Commercial and Medicare risk adjustment efforts and requires expert coding skills.

The ideal candidate has 3–5 years in risk adjustment coding, AHIMA/AAPC certification, and a strong grasp of documentation improvement within a managed care environment.