Risk Adjustment Coding Advisor

Cotiviti is seeking a Risk Adjustment Coding Advisor to join our Risk Adjustment team. This role involves leveraging clinical, coding, documentation, and analytical skills to develop technology solutions for Health Plans and Providers. The ideal candidate will possess a unique combination of technical ability, clinical experience (including ICD-10 coding and clinical documentation), and problem-solving skills. This is temporary 3 month position.

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:

• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• 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.
• No adverse environmental conditions are expected.

Base compensation ranges from $40 to $45 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Date of posting: 6/19/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 07/19/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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