Risk Adjustment Compliance Coding Specialist, Consultant

Job description

Your Role The Risk Adjustment Compliance Coding Specialist (Consultant) helps to ensure organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medi-Cal (Medicaid), and Medicare Advantage lines of business. Specifically, the role helps to ensure the accuracy, completeness, and integrity of medical coding for risk adjustment programs. This specialist reviews clinical documentation and medical records to verify that all diagnoses and procedures are properly captured and coded in accordance with regulatory standards. By doing so, the specialist helps healthcare organizations meet compliance requirements for federal and state risk adjustment initiatives by supporting appropriate reimbursement, accurate risk stratification, and quality improvement efforts. Your Work: In this role, you will: - Comprehensive Record Review: Examine patient medical records, encounter notes, lab results, and physician documentation to identify all relevant diagnoses and health conditions that affect risk adjustment scoring. - Accurate Code Assignment: Assign ICD-10-CM codes, including Hierarchical Condition Categories (HCC), based on thorough review of clinical evidence a...