What are the responsibilities and job description for the Certified Risk Coders position at CSTS Customer Service and Technology Solutions LLC?
Job Title: Certified Risk Coder (CRC) – Risk Adjustment & Compliance
Position Summary:
We are seeking two experienced Certified Risk Coders (CRCs) to join our team and support risk-adjustment, coding quality, and compliance functions. In this role, you will perform accurate HCC and ICD-10-CM coding, ensure compliance with CMS V28 guidelines, conduct quality assurance (QA) audits, and help maintain regulatory and payer-specific standards.
A clinical license (RN or LPN) is a plus but not required. Candidates must have strong expertise in hierarchical condition categories (HCCs), chronic condition capture, and documentation interpretation.
Key Responsibilities:
Risk Adjustment Coding & HCC Capture
- Review medical records across multiple specialties to identify and assign accurate ICD-10-CM and HCC codes.
- Ensure diagnoses meet CMS V28 criteria, including MEAT/SOE documentation standards.
- Collaborate with providers to clarify documentation and capture chronic/high-impact conditions.
- Identify missed coding opportunities to improve RAF score accuracy.
Compliance & Quality Assurance
- Conduct retrospective and prospective QA audits for coding accuracy and compliance.
- Ensure adherence to CMS, OIG, HIPAA, RADV, and payer-specific risk-adjustment regulations.
- Track error trends and support provider/coder education initiatives.
Provider & Team Collaboration
- Communicate coding clarifications to providers using compliant query standards.
- Support education on chronic disease documentation, HCC changes, and V28 updates.
- Collaborate with clinical and revenue cycle teams to align risk-adjustment processes.
Data Integrity & Reporting
- Maintain accurate records of coding work and audit findings.
- Provide feedback on RAF score impacts and compliance risks.
- Participate in coding meetings and calibration exercises.
Required Qualifications:
- Active CRC credential (AHIMA or AAPC) required.
- 2 years (4 preferred) of risk-adjustment coding experience (HCC and ICD-10-CM).
- Strong knowledge of CMS HCC V28, MEAT/SOE standards, and risk-adjustment methodologies.
- Proficiency with EMR/EHR systems and coding platforms.
- Excellent analytical, auditing, and communication skills.
Preferred Qualifications:
- Clinical license (RN, LPN, LVN) helpful but not required.
- Additional certifications (CCS, CPC, CPMA) a plus.
- Experience with Medicare Advantage, ACA risk adjustment, or ACO REACH programs.
- Familiarity with RADV audits and prospective/retrospective coding programs.
Why Join Us?
- Work in a mission-driven healthcare organization improving care quality and compliance.
- Supportive team environment with growth in V28 compliance and risk-adjustment strategy.
Pay: $70,000.00 per hour
Expected hours: 40 per week
Work Location: Remote
Salary : $70,000