Florida Licensed Risk Adjustment QA Reviewer

Key Responsibilities: Serve as the primary escalation resource for complex coding, documentation, compliance, and risk adjustment questions Perform advanced reviews of medical records to validate diagnosis coding accuracy and appropriate HCC capture Act as an indirect team lead by providing guidance, training, and coaching to coding staff while supporting consistency across coding activities

Required Qualifications: Extensive knowledge of Medicare risk adjustment methodologies and HCC coding Proficiency in ICD-10-CM guidelines and documentation requirements Experience in resolving complex coding and documentation issues Ability to analyze coding, documentation, and provider trends for improvement opportunities Experience in training and developing coding staff