HCC | Risk Adjustment Coder

Job Title: HCC | Risk Adjustment Coder
Location: Newark, NJ (100% Remote)
Duration: 6 months (possible extension)
Pay Rate: $30 - $35/hr. on W2

Schedule: Regular Business Hours.

Important Details:

• Candidates can be located in any one of the five states: NJ, NY, PA, CT, and DE
• You will be required to travel for the pickup and return of equipment, and/or laptops that need servicing.

Job Summary:

• Responsible for reviewing, auditing, coding, and analyzing medical records to ensure accurate diagnosis documentation and HCC abstraction. Supports Medicare, Medicaid, Commercial Risk Adjustment programs, and RADV audits while ensuring compliance with ICD-10 coding guidelines and risk adjustment regulations.

Key Responsibilities

• Review medical records for coding accuracy, completeness, and compliance
• Abstract and validate HCC diagnoses using ICD-10, CPT, and HCPCS coding systems
• Support Medicare Advantage, Medicaid, Commercial, and ACA risk adjustment initiatives
• Participate in coding audits, chart reviews, and quality improvement activities
• Provide coding guidance and education to internal stakeholders
• Maintain productivity and accuracy standards

Requirements

• RHIT, CPC, or CCS certification required
• 2–5 years of Medical Coding experience
• Minimum 2 years of Health Insurance, Chart Audit, Risk Adjustment, or Utilization Review experience
• Strong knowledge of ICD-10, CPT, HCPCS, and medical terminology
• Proficiency with Microsoft Office (Word, Excel)
• Strong analytical, communication, and problem-solving skills

Preferred

• Bachelor's Degree
• Experience with HCC Coding, RADV Audits, Risk Adjustment, or Quality Chart Reviews

Ideal Candidate

• Experienced Medical Coder with strong HCC/Risk Adjustment knowledge, chart auditing experience, and expertise in ICD-10, CPT, and HCPCS coding within a health plan or insurance environment.

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