Senior Risk Adjustment Coder RADV Specialist (Remote)

Metaintro, Inc.; Morgan Hill (CA); Hybrid; USD 80,000 - 110,000; Full time

Benefits offered by this job

Two monitors provided

Laptop provided

Headset supplied

Job summary

Metaintro, Inc. is seeking a remote Risk Adjustment Auditor with 5+ years of experience in CMS/HHS RADV reviews. You will review medical records for HCC support, ensure coding accuracy, and work with client Medical Directors on complex codes.

Requirements include CRC certification through AAPC/AHIMA, strong Excel skills, and knowledge of ICD-10 guidelines. Remote role with national scope; equipment provided (two monitors, laptop, keyboard, mouse, headset).

Qualifications

• 5-7 years in professional coding experience, hospital or related setting.
• Knowledge of insurance claims processing.

Responsibilities

• Reviews unlisted procedure codes to determine if a more specific code exists.
• Provides pricing information to client Medical Director regarding unlisted codes.
• Conducts meetings with state clients to discuss procedure code coverage and ensures coding decisions are implemented.
• Archives all Procedure Code Workgroup agendas, minutes and related materials.
• Maintains HIPAA reason and remark code lists and shares updates with the HIPAA Code Workgroup.
• Supports Claims by working edit reports as assigned.
• Communicates coding issues and updates to Providers to ensure timely claim payments.
• Maintains a library of code books and resources for personnel.

Skills

CRC Certification

Risk adjustment auditing

CMS RADV experience

HCC review

Excel skills

ICD-10 guidelines

Medicare Advantage

ACA familiarity

Education

Bachelor's degree or equivalent

Tools

MS Excel

Job description

Metaintro, Inc. is seeking a remote Risk Adjustment Auditor with 5+ years of experience in CMS/HHS RADV reviews. You will review medical records for HCC support, ensure coding accuracy, and work with client Medical Directors on complex codes.

Requirements include CRC certification through AAPC/AHIMA, strong Excel skills, and knowledge of ICD-10 guidelines. Remote role with national scope; equipment provided (two monitors, laptop, keyboard, mouse, headset).