Certified Risk Adjustment Coding Specialist

Floridafull timeRemote

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entry

$60k–$75k

H1B: no

Bluestone Certified Risk Adjustment Coding Specialist at Bluestone to conduct thorough patient chart reviews to identify opportunities for accurate risk adjustment diagnostic coding. Ensure proper documentation to support disease capture and documentation by providers.

Responsibilities

Review medical records, provider documentation, and encounter notes to identify and validate reportable diagnoses.
Assign accurate ICD-10-CM diagnosis codes in accordance with official coding guidelines and CMS requirements.
Apply appropriate MEAT (Monitoring, Evaluation, Assessment, and Treatment) criteria to support diagnosis reporting.
Review documentation for HCC capture opportunities and identify unsupported, incomplete, or inconsistent diagnoses.
Identify potential documentation gaps and submit compliant, non-leading provider queries when clarification is needed.
Evaluate diagnosis coding accuracy and ensure appropriate clinical support exists within the medical record.
Support prospective and retrospective risk adjustment reviews.
Perform coding audits and participate in quality improvement initiatives.
Identify trends in coding discrepancies and communicate opportunities for improvement.
Collaborate with providers, clinical leadership, billing, coding, and quality departments.
Maintain current knowledge of CMS regulations, ICD-10-CM guidelines, and changes to risk adjustment models, including applicable HCC model updates.
Meet established productivity, accuracy, and quality performance standards.

Qualification

Education/Certification/ExperienceKnowledge/Skills/Abilities

Required

Education/Certification/Experience
Bachelor’s degree in Health Information Management, Nursing, Healthcare Administration, or a related healthcare field is preferred - Candidates without a bachelor’s degree will be considered based on an equivalent combination of relevant education, professional certifications, and extensive hands-on experience in HCC coding, clinical documentation review, and CMS compliance may be considered in place of a formal degree)
Certified Risk Adjustment Coder (CRC) certification, Risk Adjustment Coding (RAC) or related risk certification required
Minimum of 2 years of experience in healthcare coding, with a focus on Hierarchical Condition Category (HCC) coding and risk adjustment.
Knowledge/Skills/Abilities
Proficiency in reviewing and analyzing medical records for documentation deficiencies and coding opportunities.
Strong understanding of ICD-10-CM coding guidelines, particularly as they relate to risk adjustment.
Excellent communication skills with the ability to effectively interact with Bluestone providers and clinical staff.
Demonstrated experience in providing education and training to Bluestone professionals.
Detail-oriented with strong analytical and problem-solving skills.
Ability to work independently and manage time effectively in a remote or part-time role.
Knowledge of healthcare compliance regulations and privacy laws.