Risk Adjustment Coder

Job Overview
The Risk Adjustment Coder supports accurate and compliant documentation for Nurse Practitioner–led home visit programs serving Medicare patients. This role ensures high-quality coding, timely claim submission, and strong documentation practices that support Medicare reimbursement and quality outcomes.

ESSENTIAL JOB FUNCTIONS:

• Review and analyze medical records from NP home visits to assign accurate ICD-10-CM, CPT, and HCPCS codes in accordance with Medicare and industry coding standards
• Support accurate risk-adjusted documentation through compliant diagnosis coding based on provider documentation
• Manage the Provider Approval Queue (PAQ) within the Electronic Medical Record (EHR), ensuring charts are reviewed and signed by providers within required timeframes
• Ensure medical claims are submitted electronically and in a timely manner to support reimbursement
• Work closely with Nurse Practitioners and clinical staff to clarify documentation and resolve coding questions
• Identify, research, and resolve coding issues, including claim corrections and resubmissions
• Maintain current knowledge of coding guidelines, and reimbursement requirements
• Assist with implementation of annual coding updates and process improvements
• Maintain accurate records of coding activity for reporting and internal review
• Collaborate with billing and clinical teams to improve workflows and efficiency
• Participate in internal quality reviews to promote consistent and accurate coding practices
• Educate staff on documentation standards, code selection, and the importance of coding accuracy
• Maintain strict confidentiality and comply with all HIPAA requirements
• Perform other duties as assigned

QUALIFICATION REQUIREMENTS:

• High School Diploma required
• Bachelor’s degree preferred
• Certified Risk Adjustment Coding (CRC) certification required

EXPERIENCE: SKILLS, KNOWLEDGE, ABILITIES:

• Minimum of 2 years of outpatient risk coding experience
• Expert knowledge of medical terminology, anatomy, and physiology
• CRC certification required
• Strong working knowledge of ICD-10-CM, CPT, and HCPCS code sets
• Experience with provider-based risk adjustment coding
• Familiarity with EHR systems
• Ability to accurately interpret clinical documentation
• Ability to make independent coding assignment decisions
• Strong attention to detail and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Ability to work in a team environment and provide education to providers regarding risk coding
• Expert knowledge in excel
• Strong written and verbal communication skills
• Knowledge of HIPAA and patient confidentiality requirements

Pay: $80,000.00 - $95,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• Bachelor's (Preferred)

Experience:

• Outpatient risk coding: 2 years (Preferred)

License/Certification:

• Certified Risk Adjustment Coder (CRC) Certification (Required)

Work Location: Hybrid remote in Garden City, NY 11530