Concurrent Risk Adjustment Coder (CCS/CRC)

The client is a US HealthCare service provider and is looking to hire a Concurrent Risk Adjustment Coder (CCS/CRC) for their team at Hyderabad.

Department / Function:

Risk Adjustment | Coding Operations | Provider Documentation Support

Job Summary:

We are seeking a CCS or CRC-certified coder with risk adjustment (HCC) experience to perform concurrent/post-visit chart reviews . This role is responsible for full encounter diagnosis coding (all applicable ICD-10-CM codes for the visit) and HCC capture/validation using documentation available in the EHR.

Key Responsibilities:

• Perform post-visit (concurrent) chart reviews to ensure accurate and complete diagnosis capture for each encounter.
• Assign all applicable ICD-10-CM diagnosis codes for the visit, based on provider documentation and coding guidelines.
• Execute HCC capture and validation , ensuring diagnoses meet risk adjustment requirements and are supported by documentation.
• Verify diagnosis specificity and clinical support (e.g., status, acuity, laterality, complications, linkage).
• Identify documentation gaps that impact coding accuracy and communicate findings per workflow (query/escalation if applicable).
• Utilize EHR workflows effectively to review encounter notes, problem lists, assessments/plans, orders, labs, imaging, and historical records as needed.
• Maintain required productivity, turnaround time, and quality benchmarks.
• Participate in internal QA, audits, feedback sessions, and continuous improvement activities.

Required Qualifications:

• CCS or CRC certification required
• Risk adjustment/HCC coding experience (payer or provider environment)
• Strong knowledge of ICD-10-CM coding guidelines and compliant coding practices
• EHR experience
• Ability to interpret clinical documentation to support accurate diagnosis coding

Preferred Qualifications:

• Experience with post-visit/retrospective encounter coding in ambulatory/primary care settings
• Familiarity with CMS-HCC model concepts and risk-based coding workflows
• Exposure to coding quality programs and audit readiness practices

Core Skills & Competencies:

• High attention to detail with strong clinical reasoning
• Excellent time management and ability to handle volume efficiently
• Strong written communication and documentation skills
• Quality-focused mindset with adherence to compliance standards (HIPAA, client policies)

Tools & Systems:

• EHR/EMR systems
• Coding and risk adjustment tools/work queues (as applicable)
• Productivity and QA tracking tools (Excel/portals/dashboards)

Work Expectations / Metrics (Typical):

• Daily chart volume and TAT as assigned
• Accuracy and audit scores meeting defined thresholds
• Consistent documentation of coding rationale and actions taken