Job Description

Role: IT Coding Analyst (RADV)

Client is seeking a IT Coding Analyst (RADV) with a Camarillo CA-based client to join their team

Job Description

The IT Coding Analyst RADV plays a vital role in optimizing revenue performance through accurate coding and risk adjustment practices. This role requires a strong background in financial analysis, medical coding, and regulatory compliance within the Medicare Advantage or Medicaid environments. You'll collaborate with cross-functional teams to improve documentation, analyze coding data, support audits, and contribute to financial modeling that aligns with CMS and HHS requirements.

Key Responsibilities:

• Financial Analysis & Risk Adjustment Modeling
• Analyze financial data related to Medicare Advantage and Medicaid risk adjustment revenue.
• Model revenue impact based on member risk scores (e.g., HCC, RxHCC) and coding accuracy.
• Develop accrual estimates for financial reporting and forecasting tied to risk adjustment performance.

Coding Audits & Documentation Review

• Audit ICD-10-CM codes for compliance with CMS-HCC and HHS-HCC models.
• Identify and correct gaps or inaccuracies in coding and documentation.
• Collaborate with coding and clinical teams to ensure accurate submissions.

Compliance & Regulatory Support

• Ensure alignment with CMS, RADV, and HHS regulations for risk adjustment.
• Support internal and external audits by providing detailed documentation and financial justifications.
• Stay updated on evolving risk adjustment policies and coding guidelines.

Cross-Functional Collaboration

• Work with providers to assess the financial impact of documentation practices.
• Partner with teams such as actuarial, clinical, and compliance to align goals.
• Generate reports on risk scores, coding trends, and financial performance for senior leadership.

Data & Reporting

• Support development of tools to monitor risk adjustment metrics.
• Collaborate with data analytics teams to improve reporting platforms.

Qualifications:

Required:

• Bachelor's degree in Finance, Accounting, Health Information Management, or related field.
• 3 5 years of experience in financial analysis, risk adjustment, or medical coding in a health plan or managed care setting.
• Strong knowledge of CMS-HCC, HHS-HCC, and RADV processes.
• Proficient in Excel and financial modeling.
• Understanding of ICD-10-CM coding guidelines and risk adjustment methodologies.
• Strong analytical, communication, and presentation skills.

Preferred

• Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC).
• Advanced degree or certification (MBA, CFA, etc.).
• Familiarity with Medi-Cal, Medicare Advantage, and risk adjustment data submission platforms.
• Experience supporting audits and working in compliance-heavy environments.

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