Senior Risk Adjustment Coding Specialist

HireTalent; United States; Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

HireTalent is seeking a Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and ACA. The role focuses on advanced review, interpretation, and validation of clinical documentation and ICD-10-CM coding to support risk adjustment programs.

You will independently assess medical records, adjudicate AI-assisted coding recommendations, and collaborate with clinical and compliance teams to drive accurate risk scoring while meeting regulatory requirements.

Qualifications

• Bachelor's degree or commensurate work experience.
• Certified coding credential such as CPC, CRC or AHIMA equivalent required.
• Minimum 3+ years of risk adjustment coding experience for a health plan, provider, or vendor.

Responsabilités

• Independently review medical records to assign accurate ICD-10-CM codes per CMS/ACA.
• Validate and adjudicate AI-assisted coding recommendations with clinical judgment.
• Identify coding trends and opportunities affecting risk adjustment performance.
• Ensure compliance with ICD-10-CM guidelines and risk adjustment standards.
• Collaborate with clinical, operational, and compliance teams on risk initiatives.
• Conduct quality reviews and provide guidance to cross-functional stakeholders.
• Participate in regulatory audits, including Risk Adjustment Data Validation.
• Maintain productivity and manage priorities in a fast-paced environment.

Connaissances

ICD-10-CM coding

Risk adjustment concepts

Analytical reasoning

Independent judgment

Formation

Bachelor's degree in a relevant field

Certified professional coder (CPC) / CRC

Outils

EPIC

eClinicalWorks

Athena

Description du poste

HireTalent is seeking a Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and ACA. The role focuses on advanced review, interpretation, and validation of clinical documentation and ICD-10-CM coding to support risk adjustment programs.

You will independently assess medical records, adjudicate AI-assisted coding recommendations, and collaborate with clinical and compliance teams to drive accurate risk scoring while meeting regulatory requirements.