Risk Adjustment Medical Coder (Remote)

Join HealthSpective

Since 1997, HealthSpective has been a trusted healthcare management consulting firm dedicated to helping healthcare organizations improve quality, compliance, risk adjustment accuracy, and operational performance. As a nationally recognized healthcare consulting company, we partner with health plans, provider groups, and healthcare organizations to deliver expert audit support, data validation, and compliance solutions rooted in healthcare regulations and compliance best practices.

 

HealthSpective delivers end-to-end risk adjustment medical coding services to optimize RAF scores and improve clinical documentation. We are seeking a detail-oriented and experienced Risk Adjustment Medical Coder to join our growing remote team.

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Position Summary

The Risk Adjustment Medical Coder is responsible for reviewing medical records and accurately assigning diagnosis codes in compliance with CMS-HCC risk adjustment guidelines and ICD-10-CM coding standards. This role supports chart reviews and prospective coding initiatives, and data validation activities to ensure accurate risk capture and regulatory compliance.

 

This is a fully remote position ideal for a motivated professional with strong analytical skills and a passion for healthcare quality and accuracy.

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Key Responsibilities

• Review and code medical records for CMS-HCC and risk adjustment accuracy

• Ensure compliance with ICD-10-CM, CMS guidelines, and documentation standards core pillars of any sound healthcare compliance program

• Conduct prospective chart reviews

• Identify documentation gaps and opportunities for provider education

• Collaborate with clinical, quality, and consulting teams to support client initiatives

• Participate in medical CMS data validation audit and audit preparation activities

• Maintain productivity and quality benchmarks

• Stay current with evolving CMS regulations and coding updates
   

Qualifications

Required

• Minimum of 2 years of Risk Adjustment coding experience

• Bachelor's degree in Public Health, Healthcare Administration, Nursing, Health Information Management, or related field

• Active and current CRC (Certified Risk Adjustment Coder) certification

• Strong knowledge of CMS-HCC methodology and ICD-10-CM coding guidelines

• Experience reviewing electronic medical records (EMR/EHR systems)

• Excellent attention to detail and analytical skills

• Strong written and verbal communication skills

• Ability to work independently in a remote environment

 

Preferred

• Experience with Medicare Advantage programs and data validation processes

• Prior healthcare consulting or audit experience familiarity with HEDIS audit consulting services is a plus

• Additional certifications such as CPC, CCS, or RHIT/RHIA

• Knowledge of RADV or data validation processes

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What We Offer

• Fully remote work environment

• Competitive compensation

• Flexible scheduling opportunities

• Collaborative and mission-driven culture at a leading healthcare consultancy service

• Professional growth and development opportunities

• Opportunity to work with leading healthcare organizations nationwide​​​​

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