Overview In this role you will validate diagnoses and documentation to ensure accurate CMS risk adjustment capture and ICD-10-CM compliance. You will work with coding teams, providers, and operations to improve documentation quality and maintain program integrity. You help ensure RADV compliance, track performance, and support data-driven improvements. This position offers impact in risk score accuracy and regulatory adherence within a collaborative healthcare environment. ResponsibilitiesPerform bidirectional medical record reviews to validate and capture risk-adjusted diagnoses per CMS guidelinesEnsure documentation supports coded conditions per ICD-10-CM and payer guidelinesIdentify unsupported diagnoses, over- or under-coding, and documentation gapsProvide audit findings and recommendations to coding teams, providers, and leadershipMonitor and report RADV compliance and audit trendsCollaborate with coding staff, providers, and operations to improve documentation qualityAssist education and training on risk adjustment and documentation best practicesMaintain HIPAA compliance and confidentialityMeet daily/weekly productivity and quality targetsPerform other related duties as assigned Key requirementsKnowledge of CMS-HCC and HHS-HCC risk adjustment modelsKnowledge of ICD-10-CM coding guidelinesKnowledge of RADV requirementsProficiency in EMR systems and Microsoft Office (Excel preferred)High attention to detailAnalytical and critical thinking skillsClear written and verbal communicationAbility to work independently and meet deadlinesStrong organizational skillsIntegrity and commitment to complianceHealth Care Sanctions background check completedAttention to detailStrong analytical thinkingEffective communicationCMS-HCC and HHS-HCC knowledgeICD-10-CM codingRADV compliance
Not specified in the original listing.
Not specified in the original listing.
