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Risk Adjustment Coder

Job Type: Full-time

Location: Remote

About the Role

As a Risk Adjustment Coder, you will play a vital role in identifying members' health conditions and assigning precise diagnosis codes that map directly to risk adjustment models. In this role, you will help ensure our partner Independent Physician Associations (IPAs) receive appropriate funding to cover high-quality patient care. As a key member of the HEDIS/Risk Adjustment Team, you will follow structured coding workflows and maintain strict guidelines to ensure coding consistency, accuracy, and complete audit defensibility.

Key Responsibilities

• End-to-End Coding: Execute departmental coding processes, including medical record reviews, retrospective chart audits, and system data entry for claims/encounters to ensure high accuracy and specificity.
• CMS Model Compliance: Review clinical documentation to assign appropriate diagnosis codes based on effective CMS-HCC models and associated guidelines.
• Gap Closure & Audits: Support retrospective coding, prospective gap closure initiatives, and assist with health plan HCC gap report reconciliations.
• Audit Defensibility: Ensure all coding decisions align with CMS RADV and health plan validation standards to remain audit-ready.
• Provider Feedback: Collaborate with clinical teams and provide feedback to providers on documentation integrity, missing information, or necessary amendments in a timely manner.
• Regulatory Knowledge: Stay current on ICD-10-CM coding guidelines, CMS risk adjustment updates, and RADV standards.
• Team Collaboration: Work alongside other coders, managers, and clinical staff to improve coding specificity, resolve gaps, and meet departmental productivity goals.

Qualifications

Education & Certifications:

• Education: High School Diploma or equivalent (Required).
• Certifications: Active CRC, CPC, or CCS-P credential through AAPC or AHIMA (Required).

Experience:

• Minimum 2 years of experience as a Certified Medical Coder (Required).
• Minimum 1 year of dedicated Risk Adjustment Coding experience (Required).

Skills & Knowledge:

• Strong, up-to-date knowledge of ICD-10-CM diagnosis coding guidelines and CMS risk adjustment documentation requirements (Required).
• Solid understanding of RADV audits and risk adjustment data validation requirements.
• In-depth knowledge of HIPAA and relevant healthcare compliance regulations.
• Demonstrated ability to produce audit-defensible coding decisions under minimal supervision in a remote environment.
• Strong analytical, organizational, and problem-solving skills with exemplary attention to detail.
• Excellent written and verbal communication skills.

Pay: From Php432.00 per hour

Application Question(s):

• Do you currently hold an active coding certification (CRC, CPC, or CCS-P)?

(Note: CPC-A and CCA are not accepted)

• How many years of experience do you have as a certified medical coder?
• Are you comfortable with a remote role requiring 24–48 hour turnaround times per chart and independent work with minimal supervision? (Yes/No)
• Are you currently employed or working with another client? If yes, do you plan to transition to this full-time role?
• Are you willing to work the graveyard shift (U.S. time zone)?
• How many years of experience do you have specifically in Risk Adjustment Coding / CMS-HCC models? Briefly describe your experience.
• Do you have hands-on experience with RADV audits and risk adjustment data validation requirements?

Work Location: Remote