Senior Risk Adjustment Coder (RADV/HCC) - Remote

Metaintro, Inc.; Morgan Hill (CA); Remote; USD 90,000 - 120,000; Full time

Job summary

Metaintro, Inc. seeks an experienced Risk Adjustment Auditor to review inpatient and outpatient medical records for HCC support. Requires 5+ years in risk adjustment auditing with CMS/HHS RADV focus, CRC certification, and advanced Excel skills. Must be able to work remotely and meet strict accuracy targets.

Responsibilities include chart reviews, coding accuracy reviews, and client communications to ensure compliant and timely claim payments. Strong knowledge of ICD-10 guidelines is essential.

Qualifications

• 5-7 years of professional coding experience, professional or hospital.
• CRC (Certified risk adjustment coder) certification through AAPC or AHIMA.
• Experience with CMS RADV contract level audits and HHS RADV coding.
• Intermediate/advanced Microsoft Excel skills.
• Knowledge of ICD-10 Official Coding Guidelines and Coding Clinic clarifications.

Responsibilities

• Review and research billed codes to determine specificity of codes.
• Provide cover and pricing information to client Medical Director for unlisted codes.
• Conduct meetings with state clients to discuss procedure code coverage.
• Archive Procedure Code Workgroup (PCW) agendas and related materials.
• Maintain HIPAA reason and remark code lists and update relevant workgroups.
• Support Claims Department by reviewing edit reports.
• Provide coding updates to Providers to ensure timely payments.
• Maintain a library of code books and reference resources.

Skills

RADV audits

HHS RADV audits

IPM audits

Vendor coding review

Certified Risk Adjustment Coder

Excel skills

Education

Bachelor's Degree or equivalent experience

Tools

Microsoft Excel

Job description

Metaintro, Inc. seeks an experienced Risk Adjustment Auditor to review inpatient and outpatient medical records for HCC support. Requires 5+ years in risk adjustment auditing with CMS/HHS RADV focus, CRC certification, and advanced Excel skills. Must be able to work remotely and meet strict accuracy targets.

Responsibilities include chart reviews, coding accuracy reviews, and client communications to ensure compliant and timely claim payments. Strong knowledge of ICD-10 guidelines is essential.