REMOTE Medical Coding & Risk Adjustment Specialist

Location: Remote

Pay Rate: $30.00 per hour

Employment Type: Contract

Position Overview

We are seeking an experienced Medical Coding & Risk Adjustment Specialist to support risk adjustment initiatives across Medicare, Medicaid, and Commercial lines of business. This role is responsible for reviewing and analyzing medical record documentation to ensure accurate diagnosis coding, proper documentation practices, and Hierarchical Condition Category (HCC) abstraction.

The ideal candidate will have a strong background in medical coding, chart auditing, and risk adjustment methodologies, with expertise in ICD-10, CPT, and HCPCS coding standards. This individual will play a key role in supporting Risk Adjustment Data Validation (RADV) audits, Annual Commercial (ACA) reviews, and ongoing coding accuracy initiatives.

Key Responsibilities

• Review and analyze medical records to ensure documentation completeness, accuracy, and compliance with coding guidelines and regulatory requirements.

• Abstract and validate Hierarchical Condition Categories (HCCs) using ICD-9/ICD-10 coding guidelines.

• Translate and interpret CPT, HCPCS, ICD-9, and ICD-10 codes for risk adjustment and coding review purposes.

• Identify, compile, and code member and patient information utilizing established coding classification systems.

• Support Medicare Advantage, Medicaid, and Commercial Risk Adjustment programs and annual RADV audit activities.

• Assist in the collection, review, and distribution of coding and documentation improvement tools.

• Serve as a coding resource and subject matter expert for internal stakeholders.

• Participate in process improvement initiatives and coding quality programs.

• Maintain department productivity, quality, and accuracy standards.

• Stay current on coding regulations, risk adjustment methodologies, and industry best practices.

Qualifications

Required:

• Current RHIT (Registered Health Information Technician) certification OR

• Certified Professional Coder (CPC) certification through AAPC OR

• Certified Coding Specialist (CCS) certification through AHIMA

• 2-5 years of medical coding experience.

• At least 2 years of experience in health insurance chart audits, quality reviews, utilization review, or risk adjustment auditing.

• Strong working knowledge of:

• ICD-9 and ICD-10 coding

• CPT-4 coding

• HCPCS coding

• HCC risk adjustment methodologies

• Proficiency with Microsoft Office applications, including Word and Excel.

Preferred:

• Bachelor's degree in Health Information Management, Healthcare Administration, or a related field.

• Experience supporting Medicare Advantage, Medicaid, ACA, or Commercial Risk Adjustment programs.

Knowledge, Skills & Abilities

• Strong understanding of medical terminology, healthcare procedures, abbreviations, and coding regulations.

• Knowledge of healthcare delivery systems and insurance-related processes.

• Excellent analytical and problem-solving skills.

• Ability to work independently in a remote environment while collaborating effectively with a team.

• Strong written and verbal communication skills.

• Ability to ask probing questions, investigate discrepancies, and gather thorough documentation.

• Demonstrated professionalism, ethical business practices, and commitment to continuous learning and development.

Pay Details: $28.00 to $30.00 per hour

Search managed by: Tracy Galarza

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.lhh.com/us/en/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.