Certified Risk Adjustment Coder

Position Overview:

The Certified Risk Adjustment Coder (CRC) is responsible for reviewing medical records and applying accurate ICD-10-CM diagnosis codes to support risk adjustment models. This role ensures proper documentation of chronic conditions, compliance with payer requirements, and accurate reflection of patient health status for value-based care programs such as Medicare Advantage, ACA, and HCC risk adjustment. The CRC must also possess excellent spoken English to effectively communicate with physicians, compliance teams, and auditors.

Key Responsibilities:

Risk Adjustment Coding

• Review patient medical records to identify and assign appropriate ICD-10-CM codes.
• Ensure accurate documentation of chronic conditions and comorbidities.
• Apply knowledge of Hierarchical Condition Categories (HCCs), RxHCC, and other risk adjustment models.