Professional Coder I

Risk Adjustment Medical Coding Specialist (Remote – NY/PA/CT/DE/NJ Only)

Remote – Candidates must reside in one of the following states:

• New York (NY)
• Pennsylvania (PA)
• Connecticut (CT)
• Delaware (DE)
• New Jersey (NJ)

We are seeking an experienced Risk Adjustment Medical Coding Specialist responsible for reviewing, auditing, coding, and analyzing medical records for diagnosis accuracy, documentation quality, and HCC abstraction. This role supports Medicare Advantage, Medicaid, and Commercial Risk Adjustment programs, including RADV audits and annual risk adjustment initiatives.

The ideal candidate will have strong knowledge of ICD-9/ICD-10 coding guidelines, HCC coding, and medical record auditing.

• Review and audit medical records for coding accuracy and compliance.
• Abstract and translate CPT, HCPCS, ICD-9, and ICD-10 codes for HCC coding.
• Ensure accurate diagnosis capture and documentation integrity.
• Support RADV audits and risk adjustment validation activities.
• Collaborate with internal teams on coding education and process improvements.
• Maintain productivity and quality standards.

• RHIT, CPC, or CCS certification required.
• 2–5 years of medical coding experience.
• Minimum 2 years of experience in:
  • Risk Adjustment
  • HCC Coding
  • Chart Audits
  • Utilization Review
• Strong knowledge of:
  • CPT
  • HCPCS
  • ICD-9/ICD-10-CM
  • Medical terminology
• Proficiency in Microsoft Word and Excel.

Only candidates currently residing in:
NY, PA, CT, DE, or NJ will be considered.