Risk Adjustment Coder Resume Guide

Amicable Risk Adjustment Coder with 10+ years of experience in medical coding. Seeking to bring my wealth of knowledge and expertise to ABC Company, where I can apply the current coding standards while maintaining accuracy and compliance. At XYZ Corporation, completed over 7000 risk adjustment codes for Medicare Advantage (MA) members within two months, resulting in an 8% increase in reimbursements. Solid understanding of CPT-4/HCPCS guidelines as well as ICD-10 CM diagnostic codes.

Dependable and experienced risk adjustment coder with 5 years of experience coding for Medicare, Medicaid and commercial insurance plans. At XYZ Inc., worked on large-scale data sets to improve accuracy of codes used in payment systems. Expertise using CPT/HCPCS, ICD-10 CM/PCS and DRG code sets as well as E&M guidelines for correct reimbursement levels. Received recognition from colleagues for excellent work ethic and attention to detail when resolving complex coding issues.

Well-rounded risk adjustment coder with 8 years of experience in medical coding and billing processes. Skilled at accurately documenting diagnoses, procedures and treatment plans based on ICD-10 guidelines to ensure compliance with payer requirements. Seeking to join ABC Healthcare in a role that involves providing accurate risk assessment codes for patients’ records. Key achievements include reducing claim denials by 11% within 6 months.

Talented and dedicated Risk Adjustment Coder with 8+ years of experience in the healthcare industry. Proven ability to use ICD-10 and HCPCS coding principles to accurately code diagnoses, procedures, and services for various medical specialties. Experienced in conducting risk analysis and adjusting reimbursement rates according to government regulations. Strong organizational skills that ensure accuracy while meeting tight deadlines.

Proficient Risk Adjustment Coder with 5+ years of experience in medical coding and auditing. Seeking to join a team at XYZ where I can further develop my skillset and contribute to the success of a high-performing organization. Skilled in accurate risk adjustment coding for large groups, Medicare Advantage plans, Medicaid programs, PACE organizations, etc., as well as analyzing patient charts and records for correct diagnosis codes.

Hard-working risk adjustment coder with 7+ years of experience in coding and auditing medical records. Skilled in accurately assigning ICD-10 codes to ensure correct reimbursement for healthcare services. Proven record of success meeting deadlines, minimizing errors, and maintaining data accuracy according to industry standards. Seeking a position at ABC Medical Solutions to utilize my expertise in risk adjustment coding.

Energetic and detail-oriented Risk Adjustment Coder with 7+ years of experience in ICD-10 coding and Medicare Advantage claims processing. Seeking to join ABC Health Solutions to leverage knowledge of CMS guidelines, risk adjustment principles, and data validation procedures for a positive impact on patient care outcomes. At XYZ Company achieved 67% accuracy rate on complex medical records reviews within tight timelines.

Committed risk adjustment coder with 8+ years of experience in the healthcare field. Seeking a position at ABC Medical to utilize knowledge and expertise in ICD-10 coding, provider documentation review, and risk adjustment analysis. Proven success in identifying quality assurance issues while maintaining accuracy levels above 95%. Fully certified by AAPC since 2012.

• Coded over 10,000 diagnoses for inpatient and outpatient medical records using ICD-10 coding guidelines; achieved 95% accuracy rate.
• Assessed patient health risks by analyzing diagnostic codes, procedure codes and payment amounts on claims forms; identified $1 million worth of erroneous payments over a 3-year period.
• Resourcefully resolved discrepancies between diagnosis codes and billing information to ensure that all insurance claims were accurate and up-to-date before submission.
• Reviewed 500+ reports with detailed clinical descriptions to determine the most appropriate risk adjustment factor (RAF) score each month, resulting in cost savings of 15%.
• Reconciled RAF scores from previous years for 400+ patients in an effort to reduce potential audit issues; successfully reduced unapproved payments by 25%.

• Spearheaded risk adjustment coding activities for a team of 10 coders, ensuring compliance with federal regulations and overseeing the completion of over 1,500 patient charts per month.
• Participated in collaborative efforts to enhance operational efficiency; implemented new coding protocols that reduced rework by 28% and decreased turnaround times by 2 hours on average.
• Reduced total errors related to risk adjustment codes from 6% down to 0%, resulting in improved accuracy across all medical records submitted for claims processing.
• Substantially increased productivity through timely execution of various complex tasks such as reviewing clinical documentation & assigning appropriate ICD-10 codes; completed 95+ cases daily within specified deadlines without compromising quality standards or accuracy criteria set forth by CMS/AHIMA guidelines.
• Updated electronic health record (EHR) systems regularly with accurate data points captured during the chart review process, optimizing results & providing reliable outcomes regarding patient care & payment reconciliation.

• Formulated and documented medical record information to assign appropriate ICD-10 codes for over 400 risk adjustment claims, resulting in a 20% decrease in coding errors.
• Analyzed and validated patient data from providers’ electronic health records to ensure accuracy of all coded diagnoses; improved the overall quality score by 15%.
• Proficiently utilized CPT/HCPCS modifiers and E&M guidelines when assigning diagnosis codes according to accepted industry standards and practices.
• Reorganized existing databases of patients’ medical histories, claims information, lab results & prescription services with detailed attention to detail; reduced discrepancy rates by 30%.
• Interpreted physician orders accurately while optimizing reimbursement levels through the use of correct HCPCS Level II procedure code classifications; increased revenue collection rate by 10%.

• Presented and discussed risk adjustment coding audit results to medical directors, accurately identifying discrepancies and potential compliance issues; secured $400,000 in recoveries for the organization.
• Reported findings from Risk Adjustment audits on a timely basis with 95% accuracy rate; identified 10 previously overlooked errors during quarterly reviews of codes leading to additional savings of $50K+.
• Achieved 98%+ accuracy rate when reviewing documentation for assigned patient encounters and assigning appropriate ICD-10 codes; improved overall quality assurance ratings by 15%.
• Optimized process control procedures related to data collection activities across all departments by establishing best practices guidelines based on industry standards; reduced turnaround time per chart review by 50%.
• Efficiently managed workload while maintaining high level of consistency when auditing/reviewing over 300 charts daily against accepted HCC criteria set forth by Medicare Advantage programs.

• Streamlined risk adjustment coding procedures and improved accuracy by 15%, resulting in an increase of $1,000 in reimbursement payments.
• Developed protocols for capturing accurate risk-adjustment data from electronic medical records; validated over 1,200 codes across 400+ patient charts per week.
• Prepared detailed reports outlining the nature of ICD-10 diagnoses and associated complications to ensure compliance with all governing regulations while reducing errors by 10%.
• Confidently provided guidance on complex coding issues to clinical staff members and assisted in training new hire coders; reduced misidentification incidents by 20%.
• Spearheaded the implementation of a secure system that enabled remote access to confidential patient information using encrypted passwords and authentication measures for enhanced security purposes.

• Documented diagnostic and procedural codes for over 100 medical records daily, ensuring accuracy while adhering to ICD-10 coding guidelines; successfully decreased the rate of denied claims by 25%.
• Utilized a variety of software systems to review patient information and accurately identify risk adjustments; identified an average of 10+ additional diagnoses per month that had been previously overlooked.
• Independently performed quality assurance checks on coders’ data entry work, correcting errors in order to meet compliance standards set by insurance providers.
• Corrected any discrepancies between submitted documents and clinical documentation in electronic health record (EHR) system with 98% accuracy within 1 hour turnaround time frame or less when required.
• Expedited resolution process for complex cases with multiple comorbidities through comprehensive evaluation, leading to higher reimbursement rates for healthcare entities across 15 states nationwide.

• Introduced new coding protocols and auditing processes to improve accuracy of risk adjustment codes, resulting in a 24% decrease in errors.
• Improved efficiency within the department by streamlining documentation process and implementing automated systems; reduced coding time per patient record by 50%.
• Demonstrated expertise with ICD-10 CM/PCS code sets as well as HCC Risk Adjustment Model when assigning risk scores for over 1,500 patients every month.
• Reliably identified gaps or discrepancies between medical records and billing submissions to ensure compliance with CMS requirements across all levels of care.
• Compiled detailed reports on monthly claims data trends from various insurance providers, including Medicare Advantage Plans & Medicaid Managed Care Organizations (MCOs).

Associate Degree in Health Information Technology
Educational Institution XYZ
Nov 2011

Certified Professional Risk Adjustment Coder (CPC-RAC
May 2017