Risk Adjustment Coding Analyst

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Job Description:

We are seeking a Certified Risk Adjustment Coding Analyst to support accurate medical coding and ensure compliance with risk adjustment guidelines. This role plays a vital part in optimizing coding accuracy for ASAS Health while supporting revenue integrity and regulatory compliance. The ideal candidate will have a strong background in medical coding, risk adjustment methodologies, and data validation processes.

ESSENTIAL FUNCTIONS:

Medical Coding: Accurately assign diagnostic codes (ICD-10-CM) from clinical documentation following risk adjustment guidelines (Medicare Advantage, Medicaid, ACA, etc.).

Compliance & Accuracy: Ensure coding adheres to official coding guidelines, payer policies, and regulatory standards.

Chart Reviews: Conduct audits of medical records to verify code accuracy, identify discrepancies, and support compliance efforts.

Provider & Team Support: Collaborate with physicians, billers, coders, and clinician teams to enhance documentation and educate on risk adjustment best practices.

Data Analysis: Monitor coding trends, conduct data validation, and generate reports to assess risk scores and financial impact.

Continuous Learning: Stay up to date with regulatory changes, coding guidelines, and industry updates affecting risk adjustment coding. Always maintain active coding certification.

EDUCATION and EXPERIENCE

• Minimum of three years’ experience in risk adjustment coding. Preferred five years of experience in health care coding.
• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent certification preferred.

KNOWLEDGE, SKILLS, and ABILITIES:

• Strong knowledge of ICD-10-CM coding guidelines, HCC coding, and CMS regulations.
• Experience conducting audits and validations for risk adjustment accuracy.
• Excellent analytical skills with attention to detail in medical documentation.
• Strong communication and collaboration skills for provider education.
• Ability to handle multiple tasks with a high level of accuracy.
• Detail-oriented and organized.
• Strong work ethic.
• Experience with Medicare Advantage, Medicaid, or Affordable Care Act risk adjustment programs.
• Familiarity with EHR systems like Elation and Athena, and AI applications like Ambiance.
• Ability to interpret regulatory changes and apply them to coding practices.

At ASAS, we are committed to supporting the professional development of our team. New hires who join without a current Certified Coder certification are required to obtain their certification or recertification within 90 days of their start date. To support this, ASAS will reimburse up to $1500 in related expenses after you obtain your certification. Related expenses include testing, certification, courses, and materials.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!