Evaluate risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices.
Protect patient records and audit information by maintaining compliance with HIPAA, privacy, security, and regulatory requirements.
Perform retrospective and prospective chart reviews to support accurate risk adjustment reporting.
Verify the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes based on medical record documentation.
Review medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
Maintain knowledge of relevant regulatory mandates and ensure all activities remain in compliance.
Contribute to audit and production efforts to meet business demand and workload priorities.
Provide written and verbal guidance on coding errors and trends.
Meet audit deliverables within established timelines and deadlines.
Assist with special projects such as risk mitigation reviews.
Serve as a subject matter resource for the risk adjustment process and diagnosis coding for risk adjustment.
7+ years of related professional experience.
5+ years of HCC coding experience using inpatient and outpatient coding guidelines.
5+ years of experience auditing risk adjustment records.
1+ year working in a production environment.
Active CRC (Certified Risk Coder) in good standing.
Intermediate knowledge of risk adjustment Medicare, ACA Commercial, and Medicaid models.
Ability to apply critical thinking skills to coding policy interpretation and implementation.
Experience providing written and verbal guidance on coding errors and trends.
Intermediate or higher proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
Strong organizational skills with the ability to manage multiple projects in a deadline-driven environment.
High school diploma or equivalent.
Legal authorization to work in the U.S.
Medical, dental, and vision coverage
Critical illness, accident, and hospital coverage
401(k) retirement plan with pre-tax and Roth post-tax contributions
Life insurance (voluntary life and AD&D for employee and dependents)
Short- and long-term disability
Health spending account (HSA)
Transportation benefits
Employee assistance program
Time off/leave options (PTO, vacation, or sick leave)
Location
Jacksonville, Florida, US
Employment Type
Contractor
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago