Risk Adjustment Coder (HCC Specialist)

About the role

We are looking for an experienced Risk Adjustment Coder to join our team. The role focuses on accurate HCC coding, compliance with CMS guidelines, and thorough clinical documentation review. The ideal candidate holds CRC or CPC certification and delivers high‑quality coding without compromising compliance.

Key responsibilities

• Review and analyze medical records, charts, and documentation to assign accurate ICD-10-CM diagnosis codes for Risk Adjustment (HCC) models.
• Ensure coding accuracy aligns with CMS, DX‑HCC, and internal compliance guidelines.
• Validate clinical documentation to support submitted diagnoses and identify documentation gaps.
• Collaborate with QA/clinical teams to resolve coding queries and discrepancies.
• Maintain productivity and accuracy standards as defined by the organization.
• Participate in continuous audits, feedback sessions, and training programs to improve coding quality.
• Assist in identifying trends, risk areas, and opportunities for documentation improvement.
• Maintain confidentiality and compliance with HIPAA regulations.

Required profile

• Bachelor’s degree in Life Sciences, Nursing, Pharmacy, or a related field.
• Minimum 2+ years of experience in Risk Adjustment / HCC coding.
• CRC or CPC certification is mandatory.
• Strong understanding of CMS risk adjustment models, ICD‑10 guidelines, and clinical terminology.

Required skills

• ICD-10-CM coding expertise.
• HCC mapping knowledge.
• Coding compliance proficiency.
• Familiarity with EMR/EHR systems and coding platforms.