Department: Coding & Clinical Documentation

Experience Required: 4+ years in risk adjustment coding

Employment Type: Full-time

Role Summary

We are looking for an experienced Risk Adjustment Coding SME to serve as a go-to expert for our coding team in Chennai. You will review and code medical records with a high degree of accuracy, guide coders on complex cases, support quality and audit activities, and help maintain compliance with CMS-HCC, HHS-HCC, and other risk adjustment guidelines.

Work Model

- Hybrid: a combination of in-office days at our Chennai location and remote work, as per team schedule and business needs.
- Reliable high-speed internet and a secure home workspace are required for remote days, in line with HIPAA and data security policies.
- Shift timings may be aligned with US business hours, depending on project requirements.

Key Responsibilities

- Review medical records (inpatient, outpatient, physician, and specialist documentation) and assign accurate ICD-10-CM codes for risk adjustment programs (Medicare Advantage, ACA, Medicaid).
- Ensure coding supports HCC capture in line with official coding guidelines, CMS requirements, and payer-specific rules.
- Serve as the primary resource for coders on complex or ambiguous coding scenarios and documentation queries.
- Conduct quality audits, including second-level reviews and RADV-readiness reviews, and provide constructive feedback to coders.
- Identify documentation gaps and coding trends, and recommend corrective actions or provider education.
- Train and mentor new and existing coders, and conduct refresher sessions on guideline and regulatory updates.
- Contribute to developing and updating coding policies, SOPs, job aids, and training material.
- Meet or exceed productivity and accuracy benchmarks (typically 95%+ accuracy).
- Collaborate with clinical, compliance, quality,



and operations teams to resolve coding-related issues.
- Stay current with annual ICD-10-CM updates, CMS model changes, and industry best practices.

Required Qualifications

• 4+ years of hands-on experience in risk adjustment medical coding.

• Active coding certification from AAPC or AHIMA (CRC preferred; CPC, CCS, CCS-P, or equivalent also accepted).

- Strong working knowledge of ICD-10-CM guidelines, CMS-HCC and HHS-HCC models, and RADV audit processes.
- Solid understanding of anatomy, physiology, medical terminology, and disease processes.
- Experience with coding platforms, EHR systems, and encoder tools.

Preferred Qualifications

- Prior experience in a QA, auditor, trainer, or team lead capacity.
- Additional certifications such as CPMA, CDIP, or CCDS.
- Exposure to multiple risk adjustment models (Medicare Advantage, ACA, Medicaid).
- Familiarity with tools such as 3M, Optum Encoder, or similar coding software.

Key Skills and Competencies

• Communication: Clear and professional verbal and written communication for explaining coding rationale, giving feedback, and working with providers and cross-functional teams.

• Certified Coder: Proven expertise applying coding standards with a high level of accuracy and compliance.

- Attention to detail and analytical thinking.
- Coaching, mentoring, and presentation skills.
- Ability to work independently and manage deadlines in a fast-paced workplace.
- Commitment to confidentiality and HIPAA compliance.

Performance Measures

- Coding accuracy and audit scores
- Productivity against targets
- Quality of coder feedback and training outcomes
- Compliance and RADV audit results

Education

- Bachelor's degree in Life Sciences, Health Information Management, or a related field (or equivalent experience). Graduates in B.Sc. (Life Sciences), BDS, BPT, B.Pharm, or similar are welcome.

📌 Subject Matter Expert (SME) – Medical Coding, Risk Adjustment (Guindy)
🏢 Invent Health
📍 Guindy