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Job Description:

The Risk Adjustment Coder is primarily responsible for performing accurate, compliant risk adjustment chart reviews for Medicare Advantage populations. This role ensures diagnoses are fully supported, coded to the highest level of specificity, and aligned with CMS and Medicare guidelines. In addition to chart review, the role provides structured, feedback-driven provider education based on recurring documentation patterns and identified gaps to support continuous improvement in documentation quality.

Primary Responsibilities

Risk Adjustment Chart Review

• Conduct comprehensive retrospective and/or prospective risk adjustment chart reviews in accordance with CMS guidelines.

• Identify, validate, and capture appropriate HCCs supported by documentation, including chronic condition monitoring and MEAT criteria.

• Ensure diagnosis coding is accurate, specific, and compliant with ICD-10-CM and Medicare requirements.

• Document findings clearly and consistently within designated systems and tools.

• Support timely and accurate submission of risk adjustment codes through established workflows.

• Identify documentation gaps, unsupported diagnoses, or compliance risks and escalate appropriately.

• Achieves and maintains coding accuracy levels greater than 95%. 

Provider Feedback & Structured Education

• Provide clear, actionable feedback to providers and practice staff based on chart review findings.

• Support structured education efforts focused on common documentation opportunities, trends, or errors identified through chart reviews.

• Reinforce best practices for documentation and coding through targeted training sessions, written guidance, or job aids as needed.

• Serve as a subject matter resource for questions related to risk adjustment documentation and coding standards.

Collaboration & Continuous Improvement

• Partner with clinical, operational, and analytics teams to support reporting accuracy and data integrity.

• Identify recurring trends or systemic issues impacting documentation and coding accuracy.

• Contribute to workflow improvements and standardization efforts related to risk adjustment processes.

• Stay up to date with changes in coding, risk adjustment, and Medicare regulations.

Core Competencies

Analytical & Detail-Oriented

• Strong ability to review complex medical records with high accuracy.

• Identifies subtle documentation gaps and compliance risks.

• Distinguishes between clinically relevant detail and non-essential information.

Communication

• Communicates findings clearly and professionally, both in writing and verbally.

• Able to translate coding requirements into concise, practical guidance for clinicians.

• Produces accurate, timely documentation and reports.

Productivity & Organization

• Manages workload efficiently while maintaining accuracy standards.

• Meets deadlines in a high-volume chart review environment.

• Effectively prioritizes competing tasks.

Collaboration & Professionalism

• Builds credibility and trust with providers and practice staff.

• Works collaboratively across multidisciplinary teams.

• Handles sensitive information with discretion and professionalism.

Qualifications

Required

• Certified Professional Coder (CPC).

• Certified Risk Adjustment Coder (CRC) or commitment to obtain within one year of hire.

• 3–5 years of experience in medical coding, preferably Medicare Advantage risk adjustment.

• Strong working knowledge of CMS and Medicare risk adjustment guidelines.

• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding.

• Understanding of HCC categories and hierarchies.

• Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms.

• Strong written and verbal communication skills.

• Ability to work independently with minimal supervision.

Preferred

• Associate’s degree in a health-related field or equivalent experience.

• RN Licensure

• Prior experience providing provider feedback or documentation improvement support.

• Experience in value-based care or multi-site clinical environments.

Additional Requirements

• HIPAA-compliant home office for remote or hybrid roles, if applicable.

• Occasional travel (<10%) to provider sites

• Required certifications must be maintained in accordance with company policy.

Salary Range:

$59,155.20 - $78,884.00