The Senior Risk Adjustment Coder performs code audits and abstraction in accordance with state and federal regulations, internal policies, and internal procedures. This role supports quality assurance auditing and risk adjustment code abstraction for programs including Medicare Advantage Risk Adjustment.
Responsibilities include reviewing medical records for accurate HCC coding, identifying recapture and suspect diagnosis opportunities, evaluating documentation against M.E.A.T. criteria, collaborating with clinicians and cross-functional teams, and supporting coding compliance initiatives.
Requirements & Qualifications
Education
- High school diploma or GED required
- Bachelor's degree preferred
Experience
- 5+ years of experience in a risk adjustment program
- Experience supporting and communicating with clinicians in a prospective and/or concurrent role within a healthcare setting
- Knowledge of regulatory billing and coding guidelines
- Understanding of the professional revenue cycle preferred
Knowledge and Skills
- Knowledge of CPT, HCPCS, and ICD-10 codes and rules
- Ability to analyze complex problems and develop solutions
- Ability to research complex coding and regulatory guidelines
- Ability to work independently and collaboratively
- Strong judgment, decision-making, and communication skills
- Ability to prepare concise written reports and make effective oral presentations
- Ability to plan, prioritize, organize, and meet deadlines
- Knowledge of computer systems and software used in the functional area
- Knowledge of local, state, and federal regulatory requirements
- CPC and CRC certifications required
- CCDS certification preferred
Location
Newark, New Jersey, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
4 weeks ago