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Risk Adjustment Coder - Hoag Clinic Administration

Department:  Business Services
Status:  Full Time
Shift:  1st

The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record, conducts pre-visit chart preparations and post visit chart reviews, and participates in provider education programs to ensure compliance with CMS risk adjustment diagnosis coding guidelines.


Essential Functions:


  • Perform medical record reviews and ensure coding is to the highest level of specificity.
  • Communicate feedback on appropriate ICD-10-CM codes for treating physicians.
  • Perform comprehensive chart preparation and retrospective chart reviews.
  • Ensure appropriate diagnoses are submitted to the payors.
  • Collaborate with risk adjustment coding vendors to ensure company coding policies are strictly adhered to, perform regular quality assurance on vendor output. 
  • Assist in the preparation and operation of RADV audit procedures and/or participate in mock RADV audits and any other internal or external governmental audits as applicable.
  • Assist with the intake and quality assurance of medical records as necessary.
  • Comply with CMS and HIPAA regulations as well as company goals and policies.
  • Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements.
  • Maintain quality and production standards required by the company.
  • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles, and accountability.
  • Ability to work in a fast-paced production environment while maintaining high quality.
  • Participate in special projects as directed by management.
  • Perform other duties as assigned.



Education, Training, and Experience

  • Associates degree or 2+ years equivalent work experience.
  • Certified Coder (CPC, CCS, RHIT, RHIA): 2+ years required
  • Risk Adjustment Coder (CRC): 1+ years required



Skills or Other Qualifications

  • Strong knowledge of ICD-10 coding standards
  • Must have proficiency in an EHR. EPIC preferred.
  • Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
  • Excellent oral and written communication skills
  • Strong interpersonal and organizational skills



License and Certifications


Required: N/A

Preferred: N/A


Position Reports to Manager, Risk Adjustment Coding and Audit

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