Value-Based Care Risk Adjustment Coder

Profile Summary

The Value-Based Care Risk Adjustment Coder is responsible for reviewing and analyzing medical records, clinical documentation, and attribution data to ensure accurate and compliant risk adjustment coding. This role performs internal coding audits, validates coding specificity and documentation integrity, and ensures compliance with federal, state, CMS, and payer-specific guidelines. The coder partners closely with providers, billing, and clinical teams to resolve coding discrepancies, optimize risk adjustment capture, and support value-based care initiatives through accurate documentation and coding practices.

Job Details

• Work-from-home
• Monday to Friday | 11:30 PM to 8:30 AM (Manila Time)
• Will observe US Holidays

Responsibilities

• Review and analyze medical records, physician notes, medical charts, attribution data, and other relevant documents to accurately assign appropriate codes for diagnoses and procedures.

• Ensure accurate coding of services for assigned specialties/ Accurately identify and explain provider coding/billing mistakes.

• Maintain up-to-date knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines and industry changes.

• Have a robust understanding of Value-Based Care and the impact of risk adjustment coding.

• Collaborate with billing to address coding discrepancies for PCP’s, provide guidance on risk adjustment coding and PCP billing and insurance teams to address coding discrepancies and resolve any issues that may arise.

• Conduct internal audits to ensure compliance with federal, state, and payer-specific regulations.

• Provide support and guidance to medical staff and colleagues regarding proper documentation and coding practices. / Review all visits completed for original Medicare patients by PCPs to ensure accuracy in documentation and coding of ICD-10 and CPT codes with particular emphasis on HCC codes, review problem lists of Medicare patients to ensure all HCC codes are specified to the highest degree, work with VBC Manger to create trainings around risk adjustment coding for the staff and providers, attend trainings with Privia’s risk adjustment specialist, provide support and guidance to medical staff, providers, and billing team regarding proper documentation and coding practice.

• Participate in continuing education programs and maintain professional certifications.

• Maintain strict confidentiality and adhere to all HIPAA guidelines and regulations.

• Must follow company policies, procedures, and workflow/ Adhere to company policies, procedures, and workflow at all times.

• Become familiar with the Epic system and the billing process at the company.

• Meeting productivity requirements and attendance.

• Will be following the 6-month probationary period.

• Perform other duties as assigned by management.

Qualifications

• 3+ years of experience in medical coding.

• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines.

• Experience with Value-Based Care and risk adjustment coding.

• Familiarity with the Epic system and the medical billing process.

• Ability to identify and explain coding and documentation errors to providers.

• Knowledge of federal, state, CMS, and payer-specific coding guidelines.

• Strong attention to detail and accuracy.

• Good communication and interpersonal skills.

• Strong organizational and time management skills.

• Professional, reliable, and able to maintain confidentiality.