Risk Adjustment Coding Specialist I

Job Description Summary

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Summary

Reviews medical records and supporting documentation to identify and validate diagnosis information

used in risk adjustment coding. Applies established coding guidelines, payer requirements, and

departmental procedures to routine records and refers documentation gaps or coding questions for

review. Maintains accurate records of completed work and supports the timely capture of documented

patient conditions.

Work is performed under close supervision and follows established processes and procedures. Decisions

are made within defined guidelines and escalated when issues fall outside standard protocols.

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How will you make an impact & Requirements

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Key Responsibilities

Review medical records to identify clinical documentation supporting diagnosis reporting and risk

adjustment activities.

Validate diagnosis codes selected by providers to ensure documentation supports accurate and

compliant coding.

Support prospective and concurrent coding review activities designed to improve diagnosis

capture and documentation quality.

Collaborate with providers and internal stakeholders to obtain clarification regarding

documentation requirements.

Maintain knowledge of ICD-10-CM coding guidelines, Medicare risk adjustment principles, and

documentation requirements.

Participate in coding education, training programs, and quality improvement initiatives.

Meet established productivity and quality standards while maintaining coding accuracy.

Protect the confidentiality and integrity of patient information in accordance with organizational

policies and regulatory requirements.

Qualifications

High school diploma or GED required

Active coding credential through AAPC or AHIMA required; CRC preferred

Minimum one year of healthcare, outpatient, coding, or related medical experience preferred

Working knowledge of ICD-10-CM coding conventions and medical terminology

Foundational understanding of anatomy, physiology, disease processes, and pharmacology

Familiarity with Medicare risk adjustment and HCC coding concepts preferred

Proficiency using electronic health record systems

Strong attention to detail and analytical skills

Ability to work within established procedures and prioritize assigned work

Commitment to maintaining professional certification and ethical coding standards

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Compensation Range:

$22.00

to

$33.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Originally posted on Himalayas