Coder 1/HCC Risk Adjustment

Overview

The Coder I is responsible for conducting accurate, compliant, and complete diagnosis code abstraction for Medicare, Commercial, and Medicaid risk‑adjustment programs across a variety of chart types. This role applies ICD‑10‑CM Official Guidelines, AHA Coding Clinic guidance, and Cotiviti/client‑specific requirements to ensure high‑quality coding outcomes. The Coder I utilizes established dispute‑resolution processes when coding disagreements arise and communicates professionally with team leadership regarding findings, errors, and improvement opportunities.

 

We are currently looking for multiple Remote Risk Adjustment / HCC Coders (Coder 1) for full-time permanent positions.

 

See what it's like to work as a Coder at Cotiviti:https://www.youtube.com/watch?v=-VgcV09cxCo

Responsibilities

• Reviews medical records for accurate, compliant, and complete diagnosis code abstraction from a variety of chart and encounter types.to support Medicare, Commercial and Medicaid prospective, concurrent and retrospective risk adjustment program initiatives.
• Stays current on coding guidelines necessary for the position by attending all Cotiviti required trainings, workshops, and personal research as appropriate.
• Professionally communicates finds, errors, and suggestions to Team Lead to facilitate on-going communications and efficient department operations as part of a continuous improvement process.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting. 
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation. 

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

 

Qualifications

Education: Minimum High School Diploma.

 

Certifications: Nationally certified coder in good standing through AAPC or AHIMA (CRC, CPC, CCS, etc.).

 

Experience: 

• Coder 1: 1-2 years’ experience in medical risk adjustment / HCC coding.
• Experience in HCC record abstraction and coding requirements.
• Demonstrated high level of quality accuracy and productivity in clinical coding work.
• Maintains professional credential in good standing as required by AAPC and/or AHIMA. 
• Experience in HCC record abstraction and coding requirements.
• Demonstrated high level of quality accuracy and productivity in clinical coding work.
• Adherence to official coding guidelines, coding clinic determinations, CMS, Client specific guidelines and other regulatory compliance guidelines and mandates.
• Strong knowledge of medical terminology and anatomy and physiology.
• Intermediate skills and knowledge of computers with the ability to use the designated coding platform for coding processes with focus on both production and accuracy.
• Skills in organization and time management.
• Ability to read and understand medical record documentation for diagnosis extraction.
• Comfortable with computers and technology.
• Must abide by all HIPAA and associated patient confidentiality requirements.
• Required hours for training: Monday-Friday 8 AM – 5 PM ET
• Required working hours: 40 hours per week, Monday-Friday 8-hour days; daytime schedule based on your time zone. This role is not intended to work nights, weekends or part-time.

Mental Requirements:

• Excellent written and communication skills with the ability to understand and explain complex information.
• Ability to regularly and consistently achieve over 95% quality accuracy.
• Ability to appropriately communicate with management regarding workload, production expectations and deliverables.
• Quick learner with positive attitude.
• Must be able to work in a fast-paced environment.
• Ability to manage and meet deadlines.
• Adaptability to changing priorities, flexible and open to new ideas.

Physical Requirements and Working Conditions:

• Must participate in all required training.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wr