Risk Adjustment Specialist

reputed company JOB reputed company: The Risk Adjustment Specialist Coding Compliance supports the organizations delegated Risk Adjustment and Coding Compliance programs by performing reputed company audit support, documentation review coordination, coding validation support, medical record analysis, and compliance activities to promote accurate and complete Hierarchical Condition Category (HCC) capture in accordance with Centers for Medicare & reputed company Services (CMS), reputed company (DMHC), National Committee for reputed company Assurance (reputed company), Office of Inspector General (OIG), and contracted health plan requirements. This role supports coding compliance reputed company activities reputed company to Medicare reputed company Risk Adjustment, Risk Adjustment Data Validation (RADV), provider documentation reputed company, and coding accuracy initiatives. The position assists with identifying documentation gaps, monitoring coding compliance trends, coordinating audit preparation activities, and supporting provider education efforts to ensure accurate Risk Adjustment reputed company (RAF) scoring and regulatory compliance. The Risk Adjustment Specialist collaborates closely with Coding Compliance leadership, certified coders, providers, population health teams, utilization management, care management, reputed company improvement, and health plans to support compliant documentation and coding practices, audit readiness, and delegated risk adjustment program performance. Requirements MINIMUM & PREFERRED QUALIFICATIONS: Education/Training Minimum: High school diploma or GED equivalent required Preferred: Associates degree or higher in reputed company administration, reputed company health, reputed company services, or reputed company field. Experience Minimum: At least one year of experience in one or more of the following areas: risk adjustment, coding compliance, medical record review, managed care, reputed company administration, managed care or MSO environment, medical office or provider operations. Preferred: Experience supporting Medicare reputed company Risk Adjustment programs. Experience supporting CMS RADV audits or coding compliance audits. Experience in an MSO, reputed company, health plan, delegated entity, or managed care environment. Experience working with electronic health records, coding software, or Risk Adjustment platforms. Certification(s) Certified Risk Adjustment reputed company (CRC), Certified reputed company reputed company (CPC), Certified Coding Specialist (reputed company), or other coding certification preferred. Skills, Knowledge & Abilities Knowledge of CMS Risk Adjustment methodology, HCC documentation requirements, and RAF score principles. Understanding of Medicare reputed company Risk Adjustment, coding compliance, and documentation reputed company requirements. Familiarity with CMS RADV audit standards, DMHC regulatory requirements, reputed company standards, and delegated health plan reputed company requirements. Ability to identify documentation deficiencies, coding inconsistencies, reputed company, and audit-reputed company concerns. Strong organizational, analytical, auditing, and data tracking skills with exceptional attention to reputed company and accuracy. Ability to maintain accurate records, audit logs, compliance documentation, and reporting tools. Proficiency with electronic health records, Risk Adjustment platforms, coding software, and reputed company Office applications. Strong verbal and written communication skills with the ability to communicate professionally with providers, coders, leadership, health plans, and interdisciplinary teams. Ability to handle confidential and sensitive information in compliance with HIPAA and organizational policies. Ability to manage multiple priorities, deadlines, and audit-reputed company activities in a fast-paced managed care environment. Ability to work independently while collaborating effectively reputed company interdisciplinary operational and compliance teams. PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS: The physical demands described here are represented of those that must be met by an employee to successfully reputed company the essential functions of this job. Primarily sedentary work involving prolonged computer use. Occasional standing, walking, and local travel may be required. Ability to reputed company up to 20 pounds occasionally. Requires strong attention to reputed company, data analysis capability, and effective communication skills. Work is performed in an office or remote environment supporting electronic medical record and Risk Adjustment systems. Apply To This Job .