Medical Coder III

Medical Coder (Risk Adjustment / RADV Auditor)

Key Details

Location: 100% Remote (Must reside in an-approved state)
Duration: Contract through August 2027 with potential for extension
Schedule: Monday-Friday, 7:00 AM-4:00 PM or 8:00 AM-5:00 PM (Local Time)
Hours: 30-40 hours per week (5-10 hours OT as needed)
Work Arrangement: Fully Remote
Compensation: $21.50/hour
Employment Type: W2 (No C2C or sponsorship)

Role Overview

Our client is seeking an experienced Medical Coder specializing in Risk Adjustment and RADV auditing to review inpatient and outpatient medical records for Hierarchical Condition Categories (HCCs). This position is responsible for validating diagnosis codes, ensuring documentation meets CMS and HHS requirements, and maintaining high coding accuracy while supporting Medicare Advantage and Marketplace lines of business.

The ideal candidate has extensive experience performing CMS Contract-Level RADV, HHS RADV, and risk adjustment audits, possesses a current Certified Risk Adjustment Coder (CRC) certification, and has a strong background reviewing medical records in a production-based coding environment.

Top Responsibilities

• Review inpatient and outpatient medical records to validate HCC diagnosis coding
• Perform CMS Contract-Level RADV, HHS RADV, and IPM audit reviews
• Evaluate documentation using M.E.A.T. criteria to ensure diagnosis code support
• Maintain coding productivity and a minimum 95% coding accuracy
• Research complex coding scenarios using ICD-10 Official Coding Guidelines and Coding Clinic guidance

Key Responsibilities

• Review medical records to determine whether HCC diagnosis codes meet CMS and HHS documentation guidelines
• Validate diagnosis coding using M.E.A.T. criteria
• Perform production-based chart reviews while maintaining quality expectations
• Interpret and apply ICD-10 Official Coding Guidelines
• Utilize AHA Coding Clinic guidance and applicable Coding Clinic clarifications
• Review CMS RADV Medical Reviewer Guidance
• Research complex coding scenarios and provide coding recommendations
• Review unlisted procedure codes and determine appropriate coding alternatives
• Support claims and provider relations teams with coding guidance
• Maintain HIPAA compliance and confidentiality standards
• Document coding decisions accurately and completely
• Work independently while meeting daily production goals

Required Qualifications

• 5+ years of Risk Adjustment auditing experience
• Experience performing CMS Contract-Level RADV audits
• Experience performing HHS RADV audits
• Previous vendor coding review experience
• Experience reviewing inpatient and outpatient medical records
• Ability to meet chart review production requirements
• Strong understanding of Medicare Advantage and ACA products
• Intermediate to advanced Microsoft Excel skills
• Excellent written and verbal communication skills
• Ability to work independently in a fully remote environment

Required Certification

• Certified Risk Adjustment Coder (CRC) through AAPC or AHIMA (Required)