Medicare Risk Adjustment Coding Specialist

American Health Partners

Medicare Risk Adjustment Coding Specialist responsible for conducting coding audits at American Health Plans. Collaborating with providers to ensure accuracy in coding and documentation.

Posted 4/29/2026full-timeRemote • Tennessee • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Conducting coding audits prior to payment release.
Performing post-payment coding reviews with overpayments.
Sending coding education correspondence to applicable providers.
Reviewing medical records, patient medical history and physical exams.
Assisting with validation audits to evaluate medical record documentation.
Interpreting medical documentation to ensure coding captures HCC conditions.
Developing tools and metrics to improve coding and documentation accuracy.
Providing high level of customer service to internal and external clients.
Escalating appropriate coding audit issues to management.
Participating in and supporting ad-hoc coding audits as needed.
Supporting ongoing programs to minimize organizational risk in RADV Audits.
Completing assigned coding projects.
Other duties as assigned.

Requirements

What you’ll need

High school or equivalent degree
2 years’ experience with complex claims processing and/or coding auditing experience in the health insurance industry or medical health care delivery system
2 years’ experience in managed healthcare environment related to claims and/or coding audits
2 years’ experience with standard coding and reference materials used in a claim setting such as CPT4, ICD10, HCPCS and others
2 years’ experience with CMS requirements regarding claims processing and coding, especially skilled nursing and other complex claim processing rules and regulations
2 years’ experience coding/auditing claims for Medicare and Medicaid plans
Significant HCC experience (including knowledge of HCC mapping and hierarchy)
Coding certification required (CPC or CRC)
Travel may be required

Benefits

Comp & perks

Affordable Medical/Dental/Vision insurance options
Generous paid time-off program and paid holidays for full time staff
TeleDoc 24/7/365 access to doctors
Optional short- and long-term disability plans
Employee Assistance Plan (EAP)
401K retirement accounts with company match
Employee Referral Bonus Program

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

coding auditscoding reviewsclaims processingcoding educationmedical record documentationHCC conditionscoding accuracyCPT4ICD10HCPCS

Soft Skills

customer servicecommunicationproblem-solvingattention to detailorganizational skills

Certifications

CPCCRC