Risk Adjustment Coding Specialist II

Responsibilities

• Abstract and assign ICD‑10‑CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher‑level coders.
• Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
• Perform comprehensive reviews of provider actions within the Value‑Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
• Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
• Keep leadership aware of project activities through written and oral updates;
• proactively identify project risks.
• Consistently meet or exceed accuracy and productivity benchmarks.
• May be assigned additional projects or a higher workload volume than a Level I specialist. ‎
• How will you make an impact & Requirements
• ‎
• RISK ADJUSTMENT CODING SPECIALIST

Requirements

• Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
• Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
• Extensive understanding of ICD‑10‑CM conventions, documentation standards, and reimbursement systems.
• Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
• Demonstrated ability to use a variety of electronic medical record systems.
• Ability to manage a significant workload and meet deadlines with minimal supervision.
• Strong organizational, analytical, mathematical, and problem‑solving skills.
• Effective written and verbal communication abilities.
• Experience contributing to project work, educational development, or group presentations.

Benefits

Additional Information

Job Description Summary ‎

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