HCC / Risk Adjustment Coder - Remote
Risk Adjustment / HCC Coding Experience Required
Required Education
- High School Diploma required with submission
Required Certifications
Online certification verification required with submission.
Candidates must possess one of the following certifications:
- Certified Professional Coder (CPC) - AAPC
- Certified Risk Adjustment Coder (CRC) - AAPC
- Certified Coding Specialist (CCS) - AHIMA
- Registered Health Information Technician (RHIT) - AHIMA
- Registered Health Information Administrator (RHIA) - AHIMA
CRC Certification is highly preferred.
Schedule
- Monday - Friday
- Occasional weekend coverage may be required based on client needs
Important Screening Questions
Risk Adjustment Coders frequently work remotely and may hold multiple positions simultaneously.
Always ask:
- Do you currently hold a CPC, CRC, CCS, RHIT, or RHIA certification?
- How many years of Risk Adjustment/HCC coding experience do you have?
- What Risk Adjustment platforms have you used?
- Have you performed prospective, concurrent, or retrospective HCC reviews?
- Are you familiar with CMS-HCC and/or HHS-HCC methodologies?
- Are you currently working another full-time or part-time position?
- If yes, please explain your schedule and any potential conflicts.
Position Summary
The HCC / Risk Adjustment Coder is responsible for reviewing medical records and clinical documentation to accurately identify, validate, and code chronic and acute conditions impacting patient risk scores and reimbursement.
The coder will ensure accurate assignment of ICD-10-CM diagnosis codes in accordance with CMS Risk Adjustment guidelines, Official ICD-10-CM Coding Guidelines, and client-specific requirements. This role supports Risk Adjustment initiatives through retrospective chart reviews, prospective reviews, coding validation, provider education support, and quality assurance activities.
The HCC Coder will collaborate with providers, CDI professionals, quality teams, population health departments, and coding leadership to ensure complete and accurate capture of chronic conditions and disease burden.
Key Responsibilities
- Review medical records to identify and code HCC-eligible diagnoses.
- Assign ICD-10-CM diagnosis codes in accordance with CMS and Risk Adjustment guidelines.
- Validate chronic conditions and ensure documentation supports code assignment.
- Perform retrospective and prospective chart reviews.
- Identify missed HCC opportunities and documentation gaps.
- Assist with coding validation and quality assurance audits.
- Support provider education initiatives regarding Risk Adjustment documentation requirements.
- Maintain productivity and quality standards established by the client.
- Participate in internal and external audit activities.
- Stay current on CMS Risk Adjustment regulations, coding updates, and industry best practices.
- Assist leadership with special projects and additional duties as assigned.
Required Experience
- Risk Adjustment / HCC coding experience required
- Strong understanding of ICD-10-CM coding guidelines
- Experience reviewing outpatient and provider documentation
- Knowledge of CMS-HCC Risk Adjustment methodologies
- Experience validating chronic conditions and disease burden
- Strong attention to detail and coding accuracy
Preferred Experience
- CRC certification
- Experience with Medicare Advantage populations
- Experience with value-based care programs
- Experience performing coding audits and quality reviews
- Experience with Epic, Cerner, Athena, eClinicalWorks, NextGen, or other EMR systems
- Experience educating providers on Risk Adjustment documentation
