Certified Risk Adjustment Coder (Mount Abu)

Position Overview:

The Certified Risk Adjustment Coder (CRC) is responsible for reviewing medical records and applying accurate ICD-10-CM diagnosis codes to support risk adjustment models. This role ensures proper documentation of chronic conditions, compliance with payer requirements, and accurate reflection of patient health status for value-based care programs such as Medicare Advantage, ACA, and HCC risk adjustment. The CRC must also possess excellent spoken English to effectively communicate with physicians, compliance teams, and auditors.

Key Responsibilities:

Risk Adjustment Coding
- Review patient medical records to identify and assign appropriate ICD-10-CM codes.
- Ensure accurate documentation of chronic conditions and comorbidities.
- Apply knowledge of Hierarchical Condition Categories (HCCs), RxHCC, and other risk adjustment models.

Compliance & Quality Assurance
- Audit coding practices to ensure compliance with CMS, HHS, and payer guidelines.
- Collaborate with physicians and clinical staff to improve documentation accuracy.
- Maintain up-to-date knowledge of risk adjustment regulations and coding updates.

Data & Reporting
- Support risk adjustment data submissions for Medicare Advantage and ACA plans.
- Perform quality checks to ensure coding aligns with payer requirements.
- Assist in preparing reports for compliance, audits, and performance improvement.

Physician & Staff Education
- Provide feedback and training to physicians on documentation improvement.
- Develop educational resources to enhance coding accuracy and compliance.
- Act as a subject matter expert (SME) for risk adjustment coding queries.

Qualifications: Education: Bachelor’s degree in healthcare, life sciences, or related field preferred.

Certification: CRC credential from AAPC (mandatory). CPC certification is an added advantage.

Experience:
- 10 years of medical coding experience, with at least 5 year in risk adjustment.
- Familiarity with Medicare Advantage, ACA, and valu Apply on Kit Job: kitjob.in/job/4n8bz2