Job Title: Risk Adjustment Chart Reviewer
Department: Revenue Cycle / Quality & Compliance
Location: Remote
Reports To: MRA Manager / Coding Manager
Job Summary
The Medicare Risk Adjust (MRA) Chart Reviewer is responsible for reviewing medical records to identify and validate accurate diagnoses in support of MRA and HCC coding. This role ensures documentation of diagnoses supports all reported conditions and complies with CMS and ICD-10-CM guidelines.
Key Responsibilities
- Review patient medical charts for completeness, accuracy, and compliance with CMS Risk Adjustment guidelines
- Identify and validate HCC (Hierarchical Condition Category) diagnoses
- Ensure all chronic and acute conditions are properly documented and coded
- Perform prospective and retrospective chart reviews to identify and validate diagnoses, and to assess documentation
- Identify documentation gaps and provide feedback to providers
- Collaborate with providers to clarify documentation when needed
- Maintain productivity and quality standards
- Follow ICD-10-CM, CMS, and internal coding policies
- Support audit preparation and compliance initiatives
Qualifications
- Medical knowledge (MD, or other equivalent medical/clinical credentials/experiences preferred)
- Knowledge of ICD-10-CM and CMS Risk Adjustment (HCC) coding (CRC, CDIP, or equivalent preferred)
- Experience with medical chart reviews (minimum 1–2 years preferred)
- Familiarity with EHR systems (eCW, Epic, Athena, etc.)
- Strong attention to detail and analytical skills
- Ability to work independently and meet productivity targets
Preferred Skills
- Experience with Medicare Advantage and value-based care programs
- Knowledge of RAF score methodology
- Understanding of CMS audit processes (RADV, OIG)
- Excellent written and verbal communication skills
Performance Metrics
- Chart review productivity targets
- Coding accuracy and audit pass rate
- Turnaround time
- Provider query resolution rate
Work Schedule
Full-time / Part-time (as applicable)
Monday – Friday
Job Type: Full-time
Work Location: Remote
Job Type: Full-time
Work Location: Remote
