Review and validate medical records and documentation for coding accuracy and completeness.
Apply appropriate risk adjustment coding guidelines and compliance standards.
Support audit initiatives related to risk adjustment and data validation activities.
Analyze diagnosis coding to ensure accuracy for reporting and reimbursement purposes.
Collaborate with internal teams to resolve coding discrepancies and documentation questions.
Maintain productivity and quality standards while handling high-volume review assignments.
Ensure compliance with all regulatory, payer, and organizational coding requirements.
Participate in training updates and ongoing coding education as needed.
Accurately document findings and maintain detailed audit records.
Active CRC (Certified Risk Adjustment Coder) certification required.
Minimum of 3 years of professional risk adjustment coding experience required.
Strong understanding of ICD-10-CM coding guidelines and risk adjustment methodologies.
Experience reviewing medical records in a healthcare payer, provider, or audit environment.
Excellent analytical skills and attention to detail.
Ability to work independently and manage deadlines in a remote setting.
Strong written and verbal communication skills.
Proficiency with electronic medical records and coding software platforms.
SGC is a Certified Small Diverse Business for the Commonwealth of PA serving Harrisburg, Hershey, Mechanicsburg, Carlisle, Lancaster, Allentown, State College, York, Sunbury, Philadelphia & Baltimore.
