Risk Adjustment Consultant

Tufts University School of Dental Medicine

Risk Adjustment Consultant performing reviews and validations of Medicare, Medicaid, Commercial HCCs through medical record reviews. Collaborating with leadership to enhance coding accuracy and documentation processes.

Posted 5/15/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesJuniorMid-Level💰 $72,371 - $90,464 per yearWebsite

About the role

Key responsibilities & impact

Performs accurate and timely reviews and validations of Medicare, Medicaid, Commercial HCCs and DxCG’s through medical record reviews
Reviews provider documentation for ICD-10-CM codes to verify coding accuracy
Summarizes findings for internal and external parties and provides provider education when necessary
Collaborates with leadership to track audit results and identify trends

Requirements

What you’ll need

Certified Risk Adjustment Coder (CRC) OR must obtain within first 12 months of employment
Two (2) years of outpatient billing, coding, and risk adjustment experience
Associate’s degree highly preferred
Two (2) years of outpatient billing, coding, risk adjustment, and primary care adult medicine experience

Benefits

Comp & perks

Health insurance
401(k) matching
Flexible work arrangements
Professional development opportunities
Paid time off

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10-CM codingmedical record reviewscoding accuracyrisk adjustmentoutpatient billing

Soft Skills

collaborationcommunicationeducation

Certifications

Certified Risk Adjustment Coder (CRC)