Holy Redeemer
Certified Risk Adjustment Coding/Audit Specialist
Holy Redeemer, Huntingdon Valley, Pennsylvania, United States, 19006
OVERVIEW
Joining Redeemer Health means becoming part of an inclusive, supportive team where your professional growth is valued. Our strength comes from bringing different perspectives and talent to our workforce, spanning PA & NJ. We offer programs that set up new team members for long-term success, including education assistance, scholarships, and career training. With medical and dental coverage, access to childcare & fitness facilities on campus, investment in your retirement, and community events, your career at Redeemer is more than a job. You’ll discover a commitment to quality care in a safe environment and a foundation from which you can provide and receive personalized attention. We look forward to being a part of your professional journey. We invite you to apply today.
SUMMARY OF JOB
The Certified Risk Adjustment Coding/Audit Reviewer is a physician-facing position and must have extensive knowledge in reviewing medical charting and formulating comprehensive proactive education and audit with needed remediation upon those findings. Expertise in reviewing and revalidating accurate medical codes and diagnoses performed by physicians and other qualified healthcare providers in the office and patient home setting (e.g., outpatient setting). A sound knowledge of
medical coding
guidelines and regulations, including compliance and reimbursement, is necessary—allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models. The role involves understanding the audit process for risk adjustment models, identifying and communicating documentation deficiencies to providers to improve documentation for accurate risk adjustment coding, and possessing knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses. The Certified Risk Adjustment Coding/Audit Specialist analyzes and translates concurrent, prospective, and retrospective medical and clinical diagnoses and procedures, injuries, and illnesses into Medical Risk Adjustment (MRA) ICD-10 codes and Hierarchical Condition Categories (HCCs). The role emphasizes completeness, accuracy, and supporting clinical care plans to Risk Adjustment Data Validation (RADV) timelines. Knowledge of Medicare and Medicaid regulations, billing guidelines, and AMA’s CPT Assistant is essential. The specialist is responsible for meeting quality expectations for data abstraction and coding, maintaining productivity standards, and staying current with healthcare technology and coding advice through various educational resources. Duties are performed in accordance with outpatient-specific coding policies and procedures, supporting the mission to ensure high-quality patient care efficiently and economically. CONNECTING TO MISSION: All individuals, within the scope of their position, are responsible for performing their job in light of the Mission & Values of the Health System. Every role contributes to providing health care, ensuring that values such as Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship, and Collaboration are reflected in interactions and services. RECRUITMENT REQUIREMENTS High School Graduate. Certified coder CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment/Medicare Advantage, and/or clinical plans experience. Familiarity with Evidence-Based Medicine documentation. 1+ years of quality improvement or relevant experience preferred. Experience in healthcare and insurance industry. Knowledge of clinical standards of care, preventive health standards, and Medicare Risk Coding. The ideal candidate can read a medical chart and assign correct ICD-10-CM diagnosis codes for a variety of clinical cases and services for risk adjustment models (e.g., HCC, CDPS, HHS Risk Adjustment). LICENSE AND REGULATORY REQUIREMENTS: Education High School / GED 2-4 years relevant work experience AAPC or AHIMA Certification (CPC, CRC, CCS) REQUIRED Certified Risk Adjustment Coder – PREFERRED Knowledge Knowledge of medical and clinical terminology, disease processes, and pharmacology Proficiency in ICD-10-CM coding Must be detail-oriented with basic computer skills. Experience with computerized encoders and abstracting systems is preferred.
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medical coding
guidelines and regulations, including compliance and reimbursement, is necessary—allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models. The role involves understanding the audit process for risk adjustment models, identifying and communicating documentation deficiencies to providers to improve documentation for accurate risk adjustment coding, and possessing knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses. The Certified Risk Adjustment Coding/Audit Specialist analyzes and translates concurrent, prospective, and retrospective medical and clinical diagnoses and procedures, injuries, and illnesses into Medical Risk Adjustment (MRA) ICD-10 codes and Hierarchical Condition Categories (HCCs). The role emphasizes completeness, accuracy, and supporting clinical care plans to Risk Adjustment Data Validation (RADV) timelines. Knowledge of Medicare and Medicaid regulations, billing guidelines, and AMA’s CPT Assistant is essential. The specialist is responsible for meeting quality expectations for data abstraction and coding, maintaining productivity standards, and staying current with healthcare technology and coding advice through various educational resources. Duties are performed in accordance with outpatient-specific coding policies and procedures, supporting the mission to ensure high-quality patient care efficiently and economically. CONNECTING TO MISSION: All individuals, within the scope of their position, are responsible for performing their job in light of the Mission & Values of the Health System. Every role contributes to providing health care, ensuring that values such as Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship, and Collaboration are reflected in interactions and services. RECRUITMENT REQUIREMENTS High School Graduate. Certified coder CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment/Medicare Advantage, and/or clinical plans experience. Familiarity with Evidence-Based Medicine documentation. 1+ years of quality improvement or relevant experience preferred. Experience in healthcare and insurance industry. Knowledge of clinical standards of care, preventive health standards, and Medicare Risk Coding. The ideal candidate can read a medical chart and assign correct ICD-10-CM diagnosis codes for a variety of clinical cases and services for risk adjustment models (e.g., HCC, CDPS, HHS Risk Adjustment). LICENSE AND REGULATORY REQUIREMENTS: Education High School / GED 2-4 years relevant work experience AAPC or AHIMA Certification (CPC, CRC, CCS) REQUIRED Certified Risk Adjustment Coder – PREFERRED Knowledge Knowledge of medical and clinical terminology, disease processes, and pharmacology Proficiency in ICD-10-CM coding Must be detail-oriented with basic computer skills. Experience with computerized encoders and abstracting systems is preferred.
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