Data Integrity Specialist, ICD-10

ConcertoCare

. Review and ensure the accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions .

Posted 9/18/2026full-timeRemote • United StatesMid-LevelSenior💰 $65,000 - $75,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in ICD-10 Auditing and risk adjustment coding, ensuring compliance with CMS Risk Adjustment Methodology and internal policies. Proficient in analyzing audit trends and collaborating with Clinical Documentation Improvement teams to enhance documentation strategies.

Highest-signal resume keywords

ICD-10 AuditingRisk Adjustment CodingCoding Certification (CRC, CPC, CPC-H)Compliance StandardsMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 AuditingRisk Adjustment CodingICD-9-CM CodingCPT CodingHCPCS CodingMedical TerminologyAnatomy and Physiology KnowledgeAnalytical Problem-SolvingKeyboarding SkillsDocumentation Strategies

Soft Skills

IntegrityDiscretionMaturityAbility to Manage Multiple Priorities

Certifications & Qualifications

CRCCPCCPC-H

Industry Keywords

CMS Risk Adjustment MethodologyRegulatory RequirementsAudit ReadinessClinical Documentation ImprovementMEAT Criteria

About the role

Key responsibilities & impact

Review and ensure the accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions
Conduct pre-claim, concurrent, prospective, and retrospective audits
Maintain compliance with CMS Risk Adjustment Methodology rules and coding/documentation guidelines
Monitor daily production volume and maintain a 95%–98% accuracy threshold
Process standardized risk adjustment encounters according to cases-per-hour expectations
Perform pre-claim audits and correct improper codes before claim submission
Validate diagnoses against clinical documentation and MEAT criteria
Ensure chronic conditions are actively managed during face-to-face visits
Identify and remediate unsupported, suspect, or inaccurately coded conditions
Identify trends, missed opportunities, and improvement areas through retrospective audits
Monitor performance using accuracy trends, audit results, and turnaround times
Collaborate with Clinical Documentation Improvement teams on provider education and documentation strategies
Maintain adherence to internal compliance policies and external regulatory requirements
Support internal, external, and health plan audit readiness, including RADV and plan audits
Analyze audit trends and inform the CDI Manager about risk areas and improvement strategies
Participate in risk adjustment strategy projects, prospective programs, and suspecting initiatives

Requirements

What you’ll need

Minimum 4 years of experience in ICD-10 Auditing
Current coding certification: CRC, CPC, or CPC-H required; CPC-As not accepted
High school diploma required
Bachelor’s Degree in Healthcare, Finance, or Business preferred
Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
Advanced knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding
Knowledge of regulatory requirements and compliance standards
Proficiency in Microsoft Office Suite
Knowledge of coding and compliance standards
Knowledge of writing, grammar, spelling, punctuation, and sentence structure
Keyboarding and software skills for producing correspondence, charts, spreadsheets, and other applicable information
Analytical problem-solving orientation
Ability to manage multiple priorities
Demonstrated integrity, discretion, and maturity

Benefits

Comp & perks

Annual bonus
Full healthcare coverage
401K with match
Health, wellness, and financial benefits