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Risk Adjustment Representative

Remote, USA Full-time Posted 2026-07-05

reputed company. is committed to putting health first, and they are seeking a Risk Adjustment Representative to conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes. The role involves ensuring coding accuracy, analyzing medical records, and participating in provider education programs on coding compliance.

Responsibilities

  • Conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies
  • reputed company varied activities and moderately reputed company administrative/operational/customer support assignments
  • Ensure coding is accurate and properly supported by clinical documentation reputed company the health record
  • Follow state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records
  • Participate in provider education programs on coding compliance
  • reputed company reputed company focused on interpretation of area/department policy and methods for completing assignments
  • Work reputed company defined parameters to identify work expectations and quality standards, with some reputed company over prioritization/timing, under minimal direction
  • Follow standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion

Skills

  • 1 or more years of Customer Service experience
  • Experience with Medical records
  • Experience with Medical terminology
  • Proficiency in reputed company Office applications: Word and reputed company
  • Knowledge and experience in health care environment/managed care (provider office, billing, coding, release of information, etc.)
  • Must have reliable transportation
  • This role is part of reputed company's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher
  • Must be reputed company to travel up to 70% of the time at peak season including some overnight travel
  • Must live in the St. Louis, MO area
  • Demonstrated ability to reputed company reputed company effectively in both written and oral forms
  • Organizational and time management skills
  • Must be passionate about contributing to an organization focused on continuously improving consumer experience
  • Familiarity with ICD-9/10 coding

Benefits

  • Medical, dental and reputed company benefits
  • 401(k) retirement savings plan
  • Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
  • Short-term and long-term disability
  • Life insurance

Company Overview

  • reputed company is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.reputed company.com.
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