Medical Coding Reviewer – Risk Adjustment

GuideWell Source

. Review inpatient and/or outpatient medical records to identify and assign relevant diagnosis codes using ICD-10 classification systems .

Posted 10/8/2026full-timeUnited StatesJuniorMid-Level💰 $28 - $45 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in ICD-10 coding and compliance, with a strong understanding of medical terminology and risk adjustment processes. Proven ability to maintain high-quality standards in a production-based environment while effectively collaborating with healthcare providers.

Highest-signal resume keywords

ICD-10 CodingCertified Professional Coder (CPC)Medical TerminologyQuality Audit AccuracyMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 Classification SystemsRisk Adjustment CodingDiagnosis CodingCoding Tool EnhancementsProduction-Based Environment Experience

Soft Skills

Organizational SkillsAbility to Work IndependentlyMulti-Tasking AbilityCollaborative Skills

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookMicrosoft PowerPoint

Certifications & Qualifications

Certified Professional Coder (CPC)Certified Coding Specialist (CCSP)

Industry Keywords

Medicare AdvantageAffordable Care Act (ACA)Provider Group CodingOutpatient CodingHealth Plan Coding

About the role

Key responsibilities & impact

Review inpatient and/or outpatient medical records to identify and assign relevant diagnosis codes using ICD-10 classification systems
Ensure accuracy and compliance of risk adjustment coding
Review and validate provider-submitted and/or vendor-submitted medical record documentation and ICD-10 diagnosis codes
Identify and correct inaccuracies or discrepancies
Meet production targets while maintaining 95% quality audit accuracy
Document coder observations outside the diagnosis coding process
Assist the Provider Educator during audit results presentations by answering diagnosis coding questions
Update SOPs, DTPs and related documents
Participate in process improvement initiatives, including coding tool enhancements
Work under the direction of the Sr. Manager Risk Adjustment Audit

Requirements

What you’ll need

2+ years related work experience
High school diploma or GED
Required active Certified Professional Coder American Association of Professional Coders CPC and/or CCSP OR (AAPC) or American Health Information Management Association (AHIMA)
Ability to work independently in a remote work environment
Proficient with ICD-10-CM Guidelines for coding and reporting
Previous work experience in production-based environment
Strong understanding of medical terminology, abbreviations, body systems/anatomy, physiology and concepts of disease processes
Intermediate level of Microsoft Office proficiency (Word, Excel, Outlook, PowerPoint)
Coding or auditing experience in a Provider Group, Outpatient coding setting or Health Plan (preferred)
Knowledge of Medicare Advantage and/or Affordable Care Act (ACA-Commercial) programs (preferred)
Organizational skills, ability to work effectively in a multi-task-based environment, and ability to work independently and collaboratively (preferred)

Benefits

Comp & perks

Medical, dental, vision, life and global travel health insurance
Income protection benefits: life insurance, short- and long-term disability programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off, volunteer time off, 10 holidays and 2 well-being days
Additional voluntary benefits available
Comprehensive wellness program
Opportunities for incentive or commission compensation
Regular annual reviews with pay for performance considerations for base pay increases