Senior Risk Adjustment Coder (Remote)
Overview:
Senior Risk Adjustment Coder drives accurate risk adjustment coding through retrospective audits, chart reviews, and provider education. You partner with physicians and teams to improve documentation specificity and RAF accuracy, supporting onboarding and ongoing education. You'll lead audits, share findings, and serve as a subject matter expert on PBACO tools, shaping risk adjustment performance across targeted programs. This role blends auditing, education, and collaboration to uphold compliance and revenue integrity.
Responsibilities:
- Conduct retrospective documentation audits to verify diagnosis capture, coding accuracy, and CMS guidelines compliance
- Perform two-sided chart reviews to find documentation gaps and opportunities for recapture
- Evaluate medical records for complete support of diagnoses and M.E.A.T. criteria where applicable
- Develop and deliver physician education on documentation integrity, HCC capture, and coding guidelines
- Support onboarding of new PCPs with education and one-on-one guidance
- Provide ongoing education to PCPs based on audit trends and regulatory updates
- Track audit outcomes and collaborate with stakeholders to improve coding accuracy and program performance
- Act as subject matter expert on PBACO risk adjustment tools and pre-visit/concurrent capabilities
- Partner with PES department to drive risk adjustment improvements
Key requirements:
- 4+ years of risk adjustment coding and/or auditing experienceCRC, CPC, or CDEO certification required; multiple certifications preferred
- Bachelor's degree preferred
- Strong knowledge of HCC methodology (CMS-HCC, HHS-HCC) and ICD-10-CM coding guidelines
- Experience with auditing complex medical records and applying coding guidance
- Excellent communication and education skills for presenting findings to physicians and staff
- Proficiency with EHR systems, coding tools, audit workflows, and Microsoft Office (Excel, PowerPoint)excellent communicationstrong organizational skillsability to manage multiple audits and deadlinesCMS-HCC, HHS-HCC, ICD-10-CMEHR systemscoding tools