Risk Adjustment Coding Specialist in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Risk Adjustment Coding Specialist in the United States.

This role plays a key part in ensuring accurate clinical coding and compliance within a risk adjustment framework, directly supporting quality care and proper reimbursement outcomes. You will review medical documentation, apply HCC and M.E.A.T. coding standards, and ensure alignment with CMS and payer regulations. Working in a collaborative remote environment, you will contribute to data integrity, provider documentation improvement, and coding accuracy across patient records. The position requires strong attention to detail, coding expertise, and the ability to work independently while maintaining high compliance standards. You will also support continuous education efforts and help identify opportunities to improve documentation quality. This is a mission-driven role where precision in coding directly impacts patient care reporting and organizational performance.

In this role, you will be responsible for reviewing clinical documentation, applying accurate coding standards, and ensuring compliance with regulatory and payer requirements while supporting continuous improvement in documentation quality.

• Review and assign accurate ICD-10-CM codes using HCC and M.E.A.T. standards for provider-documented diagnoses
• Analyze clinical documentation using EHR systems and NLP tools to identify appropriate risk adjustment coding opportunities
• Ensure coding accuracy and compliance with CMS, federal, state, and payer regulations
• Identify documentation gaps and communicate improvement opportunities to coding auditors and clinical providers
• Support provider documentation improvement initiatives and recommend enhancements to coding processes
• Participate in ongoing education to maintain certification and stay current with coding standards and guidelines
• Maintain adherence to confidentiality policies and safeguard sensitive patient health information
• Collaborate with team members to ensure consistency, accuracy, and efficiency in coding workflows
• Perform additional coding, auditing, or administrative tasks as assigned

The ideal candidate is detail-oriented, analytical, and highly knowledgeable in medical coding standards, with the ability to manage multiple priorities in a fast-paced, compliance-driven environment.

• Certified Risk Adjustment Coder (CRC) required, or CPC with CRC certification required within 12 months of hire
• High school diploma or GED required
• Strong understanding of ICD-10-CM coding guidelines, HCC, and M.E.A.T. standards
• Knowledge of CMS regulations, payer requirements, and risk adjustment models
• Excellent attention to detail and accuracy in medical coding and documentation review
• Strong verbal and written communication skills
• Ability to work independently and collaboratively within a team environment
• Intermediate computer skills, including Word, Excel, Outlook, Teams, and typing proficiency
• Strong organizational skills with the ability to manage multiple tasks and deadlines
• Customer-service mindset with professionalism in communication
• Ability to adapt to changing priorities and maintain focus in a remote work environment

• Competitive pay range: $24.60 – $32.80 per hour (based on experience and location)
• 100% remote work flexibility (with potential limited travel if local)
• Comprehensive benefits package including medical, dental, and vision coverage
• Paid time off and retirement benefits (where applicable)
• Professional development and continuing education support for certification maintenance
• Opportunity to work in a mission-driven healthcare environment
• Inclusive and diverse workplace culture focused on collaboration and growth
• Exposure to advanced risk adjustment tools, coding systems, and EHR technologies