Risk Adjustment Coding Advisor

Cotiviti is seeking a dedicated Risk Adjustment Coding Advisor to join our adjustment team as a full time team member. In this role, you will serve as a strategic advisor and hands-on contributor, leveraging your clinical coding documentation and analytical expertise to drive continuous improvement and deliver comprehensive solutions for health plans and providers.

The successful candidate will bring a unique combination of technical proficiency, extensive clinical experience (including ICD-10 coding and clinical documentation expertise) and strong problem solving capabilities to support our clients' long-term success. This position offers the opportunity to make a meaningful impact while building lasting relationships with healthcare organizations and contributing to our team's continued growth and innovation.

Recommend process improvements to enhance coding quality goals and outcomes.
• Validate and troubleshoot Natural Language Processing (NLP) outputs from clinical documentation.
• Oversee coding projects, including training third-party coding vendors and reviewing coding guidelines.
• Develop content for training guides and webinars.
• Conduct training and education related to audit outcomes.
• Perform quality assurance tasks for Informatics releases.
• Collaborate with Informatics Engineers to analyze client data.
• Work with the Product Management team to integrate Informatics deliverables into existing products.
• Develop business requirements and create user workflows.
• Articulate the customer value derived from products.
• Prepare educational videos and content as needed.
• Review and understand customer coding guidelines.
• Perform user acceptance testing for products.
• Provide timely product support in collaboration with the Customer Success team.
• Integrate technology solutions with third-party vendors for customers.
• Support subject matter expert conversations with existing and new customers.
• Perform and validate code abstraction and conduct coding quality audits of medical records to ensure accurate ICD-10-CM code assignment.
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations

• Bachelor's degree or equivalent experience.
• Medical coding certification (RHIA, RHIT, CCS, CPC, or CRC) with 3-5 years of coding and auditing experience.
• LPN or RN with coding/documentation skills/certification is a plus.
• Working knowledge of risk adjustment models including CMS-HCC, HHS-HCC, and CDPS.
• Experience with standardized clinical terminologies such as ICD-10 and CPT-4.
• Excellent knowledge of coding guidelines and updates; knowledge of risk adjustment and HCC coding.
• Strong understanding of anatomy, physiology, disease processes, and medical terminology.
• Familiarity with standard clinical terminologies like SNOMED and RxNORM (preferred).
• Experience with RADV or RAC audit processes (preferred).
• Experience with at least one Electronic Health Record (EHR) system (e.g., Epic, Athena, Centricity, Cerner).
• Experience in a healthcare IT environment.
• Strong analytical, troubleshooting, and problem-solving skills.
• Willingness to learn new technical skills such as database querying.

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.
• Appropriately communicate with management regarding workload, production expectations and deliverables.
• Quick learner with the ability to manage multiple priority projects simultaneously while remaining positive.
• 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 wrists, hands and/or fingers.

Base compensation ranges from $90,000 to $110,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 06/05/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 07/05/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-AS1

#LI-Remote