What is a Medicare Risk Adjustment Coder?

Career: Medicare Risk Adjustment Coder

A Medicare Risk Adjustment Coder is a healthcare professional responsible for reviewing medical records and assigning diagnostic codes to ensure accurate risk adjustment for Medicare Advantage plans. Their work helps determine the level of reimbursement health plans receive from Medicare based on the health status and risk profile of enrolled patients. Coders must have a strong understanding of ICD-10 coding, clinical documentation, and CMS regulations. They play a vital role in compliance and in ensuring that health plans receive appropriate funding for the care of their members.