Risk Adjustment Coding Advisor – Temp - Remote

Overview

Edifecs is seeking a Risk Adjustment Coding Advisor to join our Risk Adjustment team. This role involves leveraging clinical, coding, documentation, and analytical skills to develop technology solutions for Health Plans and Providers. The ideal candidate will possess a unique combination of technical ability, clinical experience (including ICD-10 coding and clinical documentation), and problem-solving skills. This is a temporary 3 month position.

In Short

• Recommend process improvements to enhance coding quality goals and outcomes.
• Validate and troubleshoot Natural Language Processing (NLP) outputs from clinical documentation.
• Oversee coding projects, including training third-party coding vendors and reviewing coding guidelines.
• Develop content for training guides and webinars.
• Conduct training and education related to audit outcomes.
• Perform quality assurance tasks for Informatics releases.
• Collaborate with Informatics Engineers to analyze client data.
• Work with the Product Management team to integrate Informatics deliverables into existing products.
• Develop business requirements and create user workflows.
• Articulate the customer value derived from products.

Requirements

• Bachelor’s degree or equivalent experience.
• Medical coding certification (RHIA, RHIT, CCS, CPC, or CRC) with 3-5 years of coding and auditing experience.
• LPN or RN with coding/documentation skills/certification is a plus.
• Working knowledge of risk adjustment models including CMS-HCC, HHS-HCC, and CDPS.
• Experience with standardized clinical terminologies such as ICD-10 and CPT-4.
• Excellent knowledge of coding guidelines and updates; knowledge of risk adjustment and HCC coding.
• Strong understanding of anatomy, physiology, disease processes, and medical terminology.
• Familiarity with standard clinical terminologies like SNOMED and RxNORM (preferred).
• Experience with RADV or RAC audit processes (preferred).
• Experience with at least one Electronic Health Record (EHR) system (e.g., Epic, Athena, Centricity, Cerner).
• Experience in a healthcare IT environment.
• Strong analytical, troubleshooting, and problem-solving skills.
• Willingness to learn new technical skills such as database querying.

Benefits

• The expected hourly pay range for this position is $40-$45/hour.