Medical Risk Adjustment Coding

Job Description

Job Description

Job Title : Medical Risk Adjustment Coder

Job Summary

WE HAVE AN IMMEDIATE OPENING FOR A MEDICAL RISK ADJUSTMENT CODER FOR A HYBRID ROLE IN MIDTOWN MANHATTAN.  The Medical Risk Adjustment Coder is responsible for reviewing and abstracting diagnosis codes from medical records to ensure accurate and complete capture of patient risk profiles. This role supports risk adjustment programs (e.g., Medicare Advantage, ACA, Medicaid) by identifying and coding Hierarchical Condition Categories (HCCs) in compliance with official coding guidelines, payer requirements, and CMS regulations.

Key Responsibilities

• Review medical records to identify, abstract, and assign accurate ICD-10-CM diagnosis codes for risk adjustment
• Ensure coding is in compliance with CMS, HHS, and official coding guidelines (ICD-10-CM, HCC, and MEAT criteria)
• Validate documentation supports submitted diagnosis codes for risk adjustment models (HCC, CDPS, etc.)
• Collaborate with providers and clinical teams to clarify documentation and support accurate coding
• Meet or exceed productivity and accuracy benchmarks as set by the organization
• Maintain current knowledge of coding guidelines, risk adjustment models, and payer policies
• Participate in internal audits and contribute to ongoing quality improvement initiatives

Qualifications