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.