Risk Adjustment Coder

About Reveleer

Reveleer delivers a unified platform spanning risk adjustment, quality improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations nationwide, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, quality measures, and submissions. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence.

About the Role

We are seeking an experienced Risk Adjustment Coder with strong knowledge of HCC coding, CMS guidelines, RAF score calculation, and accurate clinical documentation review. The ideal candidate will be CRC/CPC certified and able to deliver high-quality coding with zero-compromise compliance standards.

Key Responsibilities

• Review and analyze medical records, charts, and documentation to assign accurate ICD-10-CM diagnosis codes for Risk Adjustment (HCC) models.
• Ensure coding accuracy that aligns with CMS, DX-HCC, and internal compliance guidelines.
• Validate clinical documentation to support submitted diagnoses and identify documentation gaps.
• Work closely with QA/clinical teams to resolve coding queries and discrepancies.
• Maintain productivity and accuracy standards as per organizational expectations.
• Participate in continuous audits, feedback sessions, and training programs to improve coding quality.
• Assist in identifying trends, risk areas, and opportunities for documentation improvement.
• Maintain confidentiality and compliance with HIPAA regulations.

Required Qualifications

• Bachelor’s degree Life Sciences, Nursing, Pharmacy, or related field.
• Minimum 2+ years of experience in Risk Adjustment / HCC Coding.
• CRC or CPC certification is mandatory.
• Strong understanding of CMS risk adjustment models, ICD-10 guidelines, and clinical terminology.

Skills & Competencies

• Excellent knowledge of ICD-10-CM, HCC mapping, and coding compliance.
• Strong analytical ability and attention to detail.
• Ability to interpret physician documentation accurately.
• Good communication and written skills.
• Familiarity with EMR/EHR systems and coding platforms.