Risk Adjustment Coder

Summary

Join Intus Care's growing team as an experienced Risk Adjustment Coder supporting our IRIS product. This role blends clinical knowledge, coding expertise, and analytical skills to ensure accurate diagnosis capture for value-based care clients. You will perform medical record reviews, validate coding accuracy using NLP technology, and identify missed opportunities. Responsibilities include supporting real-time queries, contributing to quality assurance, collaborating with clinical teams, and assisting in developing coding guidelines. The ideal candidate possesses strong clinical knowledge, coding proficiency, and experience with risk adjustment. Intus Care offers a competitive salary and comprehensive benefits.

Requirements

• Current CPC, CCS, or RHIT certification AND current CRC certification
• 5+ years of medical coding experience with risk adjustment coding background
• High School diploma required; Associate's or Bachelor's degree preferred
• Demonstrated experience working remotely and independently
• Strong understanding of healthcare regulations and risk adjustment requirements
• Clinical knowledge with proven ability to analyze medical record documentation
• Proficiency in applying coding conventions and official guidelines
• Must pass required coding examination
• Proficiency with electronic medical record systems
• Experience with coding and auditing software
• Strong computer skills and ability to learn new technologies
• Must reside in the United States of America

Responsibilities

• Perform comprehensive medical record reviews and risk adjustment coding using ICD-10-CM guidelines
• Validate diagnostic coding accuracy through natural language processing (NLP) assisted technology
• Review medical records to identify potential missed opportunities through a prospective review process
• Support real-time query processes to clarify diagnoses and identify high-risk conditions
• Contribute to quality assurance and compliance initiatives
• Collaborate with clinical teams to improve documentation practices
• Assist in developing and maintaining coding guidelines and protocols
• Participate in coding accuracy and consistency reviews
• Maintain a quality assurance score of 95% or above

Preferred Qualifications

• Additional certification in CPMA, CPCO, or CDEO
• Clinical documentation improvement experience
• Experience with Medicare Advantage or PACE programs
• Background in quality assurance or compliance auditing

Benefits

• Competitive salary package
• Comprehensive benefits including health, dental, and vision insurance
• A collaborative, inclusive, and dynamic work environment
• Opportunities for professional growth and development