Role : IT Coding Analyst (RADV)
Client is seeking a IT Coding Analyst (RADV) with a Camarillo CA-based client to join their team
Job Description
The IT Coding Analyst RADV plays a vital role in optimizing revenue performance through accurate coding and risk adjustment practices. This role requires a strong background in financial analysis, medical coding, and regulatory compliance within the Medicare Advantage or Medicaid environments. You'll collaborate with cross-functional teams to improve documentation, analyze coding data, support audits, and contribute to financial modeling that aligns with CMS and HHS requirements.
Key Responsibilities :
- Financial Analysis & Risk Adjustment Modeling
- Analyze financial data related to Medicare Advantage and Medicaid risk adjustment revenue.
- Model revenue impact based on member risk scores (e.g., HCC, RxHCC) and coding accuracy.
- Develop accrual estimates for financial reporting and forecasting tied to risk adjustment performance.
Coding Audits & Documentation Review
Audit ICD-10-CM codes for compliance with CMS-HCC and HHS-HCC models.Identify and correct gaps or inaccuracies in coding and documentation.Collaborate with coding and clinical teams to ensure accurate submissions.Compliance & Regulatory Support
Ensure alignment with CMS, RADV, and HHS regulations for risk adjustment.Support internal and external audits by providing detailed documentation and financial justifications.Stay updated on evolving risk adjustment policies and coding guidelines.Cross-Functional Collaboration
Work with providers to assess the financial impact of documentation practices.Partner with teams such as actuarial, clinical, and compliance to align goals.Generate reports on risk scores, coding trends, and financial performance for senior leadership.Data & Reporting
Support development of tools to monitor risk adjustment metrics.Collaborate with data analytics teams to improve reporting platforms.Qualifications : Required :
Bachelor's degree in Finance, Accounting, Health Information Management, or related field.3 5 years of experience in financial analysis, risk adjustment, or medical coding in a health plan or managed care setting.Strong knowledge of CMS-HCC, HHS-HCC, and RADV processes.Proficient in Excel and financial modeling.Understanding of ICD-10-CM coding guidelines and risk adjustment methodologies.Strong analytical, communication, and presentation skills.Preferred
Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC).Advanced degree or certification (MBA, CFA, etc.).Familiarity with Medi-Cal, Medicare Advantage, and risk adjustment data submission platforms.Experience supporting audits and working in compliance-heavy environments.