Risk Adjustment Coding Specialist

The Risk Adjustment Coder is responsible for reviewing and abstracting medical records to ensure accurate and complete diagnosis coding for risk adjustment purposes. This includes validating documentation using MEAT (Monitor, Evaluate, Assess, Treat) and TAMPER (Treatment, Assessment, Monitoring, Plan, Evaluation, Referral) principles to support Hierarchical Condition Category (HCC) coding. The coder also ensures accurate capture of Evaluation and Management (E) services and Current Procedural Terminology (CPT) codes to reflect the full scope of patient care and provider services. This role supports compliance, revenue integrity, and clinical documentation improvement through thorough review chart and collaboration with providers.

Responsibilities:

• Reviews and evaluates patient medical records to determine level of E/M service, office non-E/M procedures, and diagnoses. Assigns and sequences CPT, modifiers, and ICD-10 codes accurately. Abstracts and validates information.
• Reviews patient records to identify and assign ICD-10-CM codes mapping to HCCs.
• Ensures documentation meets MEAT and/or TAMPER criteria for chronic condition management.
• Collaborates with providers to clarify documentation and educate on risk adjustment coding best practices.
• Conducts retrospective and prospective coding reviews to identify missed or undocumented HCCs.
• Maintains compliance with CMS, HHS, and payer-specific risk adjustment guidelines.
• Participates in internal audits and quality assurance for coding accuracy.
• Provides feedback and training to clinical staff on documentation improvement.
• Stays current with coding guidelines, risk adjustment models (CMS-HCC, HHS-HCC), and regulatory changes.
• Trains and mentors peers and new coders on risk adjustment coding standards and documentation.
• Ensures organizational integrity by reporting actual or potential wrongdoing.

Minimum Qualifications:

• High School Diploma or equivalent.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent required; Certified Risk Adjustment Coder (CRC) preferred.
• Active and up to date CPC certification preferred.
• Minimum two years medical coding and billing experience.
• Knowledge of medical terminology, CPT, ICD-10 coding, Risk Adjustment and HCC coding.
• Understanding of medical claims formats and payer contracts.

Benefits:

• Competitive compensation and benefits including medical, dental, and vision starting day one.
• Retirement savings with employer match starting day one.
• Generous paid time off.
• Employee recognition programs.
• Tuition/professional development reimbursement starting day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (restrictions apply).
• Employee Referral Rewards.
• DailyPay option for eligible employees.
• Diversity, Equity, and Inclusion resource groups.

About Trinity Health: Mount Carmel, part of Trinity Health, is a leading healthcare system in Central Ohio with multiple facilities serving over 1.3 million patients annually. They offer extensive nursing education programs and emphasize compassionate, person-centered care. Trinity Health is an Equal Opportunity Employer.