Risk Adjustment

We are seeking a highly skilled Risk Adjustment / HCC Coder or Auditor with 2–3 years of hands-on experience to join our growing healthcare team. The ideal candidate will have a deep understanding of HCC models, HCC hierarchies, CMS guidelines, and RAF scoring and will be responsible for reviewing medical records, identifying documentation gaps, and ensuring accurate risk adjustment coding.

This role plays a critical part in supporting value-based care initiatives and optimizing reimbursement through precise HCC documentation.

Key Responsibilities

• Review outpatient, inpatient, and hospital charts for accurate HCC risk adjustment coding
• Apply correct ICD-10-CM codes following CMS Risk Adjustment guidelines
• Identify and validate HCC conditions, ensuring accurate mapping and hierarchy compliance
• Maintain strong working knowledge of HCC V24 and V28 model updates
• Perform documentation reviews and suggest improvements to provid...