REMOTE Risk Adjustment Coder - 252026

Risk Adjustment Coder & Auditor (Remote – NY/NJ/CT)

Join a growing and highly specialized Risk Adjustment team at a pivotal stage of expansion. We are seeking an experienced Risk Adjustment Coder & Auditor who thrives in a fast-paced, compliance-driven environment and is passionate about coding accuracy, audit readiness, and improving documentation quality. This is an opportunity to become a foundational member of a small, elite team focused on excellence in CMS Risk Adjustment and health plan auditing.

Position Summary

As a Risk Adjustment Coder & Auditor, you will perform detailed medical record abstraction and coding reviews to ensure accurate ICD-10-CM code assignment for HCC/Risk Adjustment models. You will play a critical role in supporting quarterly RADV audits, validating clinical documentation, and ensuring compliance with CMS and regulatory standards. This role is ideal for a coding professional with deep expertise in health plan operations, audit processes, and risk adjustment methodologies.

This is a remote, direct-hire full-time opportunity for candidates residing in New York, New Jersey, or Connecticut.

Key Responsibilities

• Conduct comprehensive medical record reviews and abstraction for accurate HCC/Risk Adjustment coding
• Assign ICD-10-CM codes in accordance with CMS guidelines and Risk Adjustment models
• Validate documentation against CMS requirements, including MEAT criteria, provider signatures, dates, and clinical support
• Support ongoing RADV audit preparation and audit readiness activities occurring quarterly
• Review coding accuracy from a health plan perspective, ensuring appropriate capture of patient complexity and chronic conditions
• Identify documentation gaps and collaborate with leadership to support provider education and documentation improvement initiatives
• Maintain productivity expectations while achieving a minimum 95% coding accuracy standard
• Assist with quality assurance reviews and compliance monitoring activities
• Stay current on CMS Risk Adjustment regulations, coding updates, and healthcare compliance standards

Required Qualifications

• Minimum 3–5 years of recent HCC/Risk Adjustment coding experience within a Health Plan, Managed Care, or Auditing environment
• Dual certification required:
• One core coding credential: CPC, CCS, RHIT, or RHIA
• Certified Risk Adjustment Coder (CRC)
• Strong working knowledge of:
• ICD-10-CM coding guidelines
• HCC/Risk Adjustment methodologies
• Clinical terminology, anatomy, physiology, disease processes, and pharmacology
• Proven ability to validate documentation for CMS compliance and audit readiness
• Demonstrated success maintaining a 95% or higher coding accuracy rate
• Familiarity with claims processing systems and healthcare regulatory requirements
• Must reside in New York, New Jersey, or Connecticut
• Dedicated home office with reliable high-speed internet required

Preferred Qualifications

• 8 years of Risk Adjustment coding and auditing experience
• Previous experience working directly within a Health Plan or Managed Care Organization
• Hands-on experience with RADV audits and audit preparation
• Inpatient coding or auditing background
• Strong analytical and documentation trend analysis skills
• Experience providing provider feedback and coding education
• Knowledge of Medicare Coordination of Benefits (COB) applications and advanced claims systems

Why Join Us?

• Direct-hire full-time opportunity with a growing team
• Competitive compensation and comprehensive benefits package
• Robust PTO package plus 10 paid holidays
• Medical, Dental, and Vision coverage
• 403(b) Retirement Savings Plan
• Education reimbursement opportunities
• Opportunity to make a direct impact on care quality and outcomes for seniors and individuals with chronic conditions throughout the tri-state area