Risk Analyst

Job Description: This role focuses on retrospective chart review and coding oversight for highly regulated Medicare Advantage risk adjustment programs. You will lead quality assurance and vendor oversight activities to ensure accurate, complete, and compliant diagnosis coding. The position requires strong attention to detail, clear communication, and the ability to manage multiple projects and quality assurance levels in a high-volume environment with minimal supervision.

Responsibilities: Conduct quality oversight audits of risk adjustment coding performed by both internal coders and external vendor coders, ensuring accuracy, completeness, and compliance with applicable guidelines. Perform detailed retrospective chart reviews to validate and assess diagnosis coding for risk adjustment purposes. Identify and appropriately add or delete diagnoses based on thorough medical record review results, ensuring accurate capture of all relevant conditions. Document and report quality assurance findings, trends, and issues to senior coding oversight specialists and leadership in a clear, structured manner. Support departmental goals by helping ensure vendor partners meet established service level agreements (SLAs) and quality standards. Collaborate closely with vendor contacts and internal team members to address coding issues, clarify documentation, and improve coding quality. Utilize AI-based coding tools and vendor platforms to review, validate, and audit coded data efficiently. Participate in multiple concurrent risk adjustment projects, adjusting priorities as needed while maintaining high accuracy and productivity. Perform additional risk adjustment and quality assurance projects as assigned to support evolving business needs. Contribute to continuous improvement of coding oversight processes by sharing observations, best practices, and recommendations. Essential Skills Current CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential. Current CRC (Certified Risk Coder) certification. Minimum of 2+ years recent experience in medical record review, risk adjustment, diagnosis coding, and/or quality auditing. 2–3 years of hands‑on experience coding risk adjustment, with the ability to hit the ground running with limited training. Proficiency using AI coding tools or similar artificial intelligence–based coding software. Strong knowledge of risk adjustment coding principles and guidelines, particularly in Medicare Advantage or similar regulated programs. Demonstrated ability to work effectively in a high-volume, production-oriented environment. Proven capability to work independently with minimal supervision while maintaining high accuracy and productivity. Excellent attention to detail and accuracy in reviewing and validating medical records and diagnosis codes. Effective written and verbal communication skills to report findings and collaborate with internal and external stakeholders. High school diploma or equivalent. Additional Skills & Qualifications Associate’s degree from an accredited college or university. Experience with Medicare and/or commercial risk adjustment processes. Experience and understanding of electronic medical and health records systems. Experience conducting formal quality assurance reviews for coding or risk adjustment. Familiarity with multiple levels of quality assurance and vendor oversight structures. Comfort working with AI-driven tools and vendor-specific coding platforms. Flexibility to manage multiple projects and shifting priorities concurrently. Strong organizational skills and the ability to maintain consistent documentation of audit results and trends. Work Environment This position supports risk adjustment projects for Medicare Advantage and potentially other risk adjustment lines of business. You will work with AI‑based coding tools and a vendor‑provided coding platform to perform retrospective chart reviews and quality oversight. The role is structured as a 6–9 month engagement with the possibility of extension or conversion to a longer‑term opportunity, depending on business needs. Standard hours are approximately 8:00 a.m. to 5:00 p.m. (Central Time), with flexibility for earlier shifts such as 6:30 a.m. to 3:30 p.m., and an expectation that team members are online by 9:00 a.m. Central Time. The team discourages working past 5:00 p.m. to support work–life balance. The position can be performed from any location and time zone within the United States, and you will collaborate remotely with team members based in multiple states. You will report to a coding oversight leader and work closely with a senior coder and vendor contacts through regular, informal meetings. Initial training spans approximately two days and is led primarily by the senior coder and oversight leader, focusing on onboarding to workflows, tools, and quality expectations. The environment emphasizes high productivity, accuracy, collaboration, and continuous quality improvement. Dress code is typical for a professional remote work setting and may be adjusted as needed for virtual meetings. Job Type & Location This is a Contract position based out of Nashville, TN.

Pay and Benefits: The pay range for this position is $35.00 - $35.00/hr.