Senior Medical Coder

CPC, CCS-P, RHIT, or RHIA (required) certified; CRC preferred 5+ years in Medicare Advantage risk adjustment, payment integrity, or quality documentation programs Deep understanding of CMS risk adjustment models, RADV, and STARS/HEDIS documentation requirements Able to partner with analytics to measure performance and quantify impact Proficient with encoders and CAC tools; curious about GenAI-assisted workflows Proven experience developing SOPs and scalable QA systems

Apply ICD-10-CM, HCC, and MEAT standards for Medicare Advantage Execute prospective and retrospective reviews to validate documentation Identify coding inaccuracies or overpayment risks and develop workflows Map documentation elements to STARS and HEDIS requirements Streamline chart reviews and coding workflows using GenAI Evaluate new tool and workflow launches for regulatory accuracy Build feedback loops and tip sheets to improve provider documentation Author SOPs, audit playbooks, and process documentation