Medical Coder

Risk Adjustment Medical Coder Location: RemoteMUST LIVE IN THE STATE OF NEW YORK, NEW JERSEY OR CTSchedule: Monday–Friday, 9:00 AM – 5:00 PM Position Overview Join a growing Risk Adjustment team at a pivotal time of expansion. We are seeking an experienced Risk Adjustment Coder & Auditor to support coding integrity, audit readiness, and CMS compliance in a highly specialized, high-impact role. This is an opportunity to be part of a small, high-performing team where your work will directly influence quality, compliance, and outcomes across a complex patient population. What You’ll Do Perform detailed medical record reviews and HCC code abstraction using ICD-10-CM guidelines Ensure accuracy and completeness of coding aligned with CMS Risk Adjustment models Support RADV audit readiness (occurring quarterly), validating documentation for compliance (MEAT criteria, signatures, dates, etc.) Evaluate coding from a health plan perspective , ensuring appropriate capture of patient complexity Identify documentation gaps and partner with leadership to provide provider education Maintain 95%+ accuracy while meeting productivity expectations Contribute to a culture of quality, compliance, and continuous improvement Required Qualifications 3+ years of recent HCC / Risk Adjustment coding experience Experience within a Health Plan or auditing environment strongly preferred Dual certification required : CPC, CCS, RHIT, or RHIA AND CRC (Certified Risk Adjustment Coder) Strong knowledge of: ICD-10-CM Clinical terminology, anatomy, physiology, pharmacology Experience validating documentation against CMS guidelines and MEAT criteria Proven ability to maintain high audit accuracy (95%+) Must reside in NY, NJ, or CT Preferred Background 8+ years of Risk Adjustment experience Direct RADV audit exposure Experience working for a Health Plan or Managed Care Organization Inpatient coding or auditing experience Strong analytical skills with ability to identify trends and support provider education Familiarity with claims systems and Medicare COB processes Why This Role Stands Out Direct Hire Stability – Full-time, permanent role (not contract-based) True Work-Life Balance – Monday–Friday, 9–5. No weekends, no overtime expectations Fully Remote (Tri-State) – Save time and money while staying connected to a respected healthcare organization Foundational Team Opportunity – Be one of the first hires and help shape the function alongside leadership High-Impact Work – Direct exposure to RADV audits and high-level CMS compliance Strong Benefits Package – PTO + 10 paid holidays, Medical/Dental/Vision, 403(b), and education reimbursement

Created: 2026-04-03