Risk Adjustment Coder III

Cano Health•Miami, FL

3d•Onsite

About The Position

The Risk Adjustment Coder III is responsible for the accurate and timely assignment of medical diagnosis codes in accordance with established risk adjustment models, coding guidelines, and organizational standards. This role performs high-volume, production-based coding and chart review activities, following defined policies and procedures to ensure compliance and data accuracy. This position applies advanced coding knowledge but operates within established guidelines, with work subject to quality review and audit.

Requirements

High school diploma or equivalent.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.
5 years of experience in medical coding with a focus on risk adjustment or HCC coding.
Extensive knowledge of ICD-10-CM coding guidelines and risk adjustment methodologies.
Experience with medical record review, documentation guidelines, and auditing.
Five (5) years prior medical coding experience (ICD-10, CPT, and HCPCS).
Expertise of Medicare Risk Adjustment methodology.
Excellent knowledge of ICD-10-CM coding conventions and guidelines.
Excellent communication skills, both written and verbal, for engaging with clinical teams, physicians, and management.
Strong analytical skills with attention to detail.
Ability to review and interpret medical records and clinical documentation effectively.
Ability to work independently and prioritize tasks in a fast-paced environment.
Demonstrated critical thinking and decision-making skills relative to clinical documentation.
Experience with medical record review and documentation auditing.

Nice To Haves

Associate’s degree or certification in Health Information Management, Medical Coding, or related field is preferred.
Certified Risk Adjustment Coder (CRC) preferred.
Additional AAPC specialty certifications (CPMA, CDEO, etc.).

Responsibilities

Assign ICD-10-CM diagnosis codes based on medical records, clinical documentation, and encounter data in accordance with established coding guidelines.
Perform detailed chart reviews to ensure accurate capture of diagnoses, including HCC codes, following risk adjustment requirements.
Identify and correct coding discrepancies based on documented evidence and coding standards.
Maintain required productivity and quality benchmarks for coding volume and accuracy.
Apply CMS-HCC and other risk adjustment coding guidelines in daily work activities.
Follow established compliance protocols to ensure coding meets regulatory and internal standards.
Participate in routine coding audits and apply feedback to improve accuracy and consistency.
Ensure all assigned codes are supported by appropriate clinical documentation.
Track and report coding errors or inconsistencies to leadership.
Maintain accuracy standards as defined by departmental performance metrics.
Work collaboratively with coding team members, clinical documentation staff, and leadership to resolve coding issues.
Provide guidance and support to junior coders as directed by leadership.
Participate in team meetings, training sessions, and workflow discussions.
Maintain current knowledge of ICD-10-CM coding updates and risk adjustment guidelines.
Complete required training and continuing education to maintain certifications.
Apply updates and changes to coding practices as directed.