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Remote Risk Adjustment Medical Coder

Guidehouse Inc.

Job Overview

Location

US - Remote (Any location)

Job Type

Full-time

Full Job Description

📋 Description

• The Remote Risk Adjustment Medical Coder at Guidehouse plays a critical role in ensuring accurate medical coding for risk adjustment, directly impacting reimbursement, compliance, and quality reporting for healthcare clients. This role is essential for maintaining the integrity of clinical data used in value-based care models and federal programs.
• Day-to-day responsibilities include reviewing clinical documentation to extract diagnoses and procedures, applying accurate ICD-10-CM, CPT, and HCPCS codes in accordance with official guidelines, and ensuring all services are properly coded for billing and reporting. The coder works through a daily review queue, corrects charts requiring re-bills within 24 hours, and communicates discrepancies to facilities and supervisors promptly.
• The role requires maintaining 95% coding accuracy while meeting productivity standards, monitoring and reporting downtime, and collaborating with IQC (Internal Quality Control) staff to uphold quality benchmarks across client facilities.
• Coders are responsible for staying current with federal and state coding regulations, maintaining professional certifications (CPC or CRC), using Guidehouse’s internal coding resources, and ensuring HIPAA-compliant workstation practices at all times.
• The position involves proactive communication—responding to provider coding/billing inquiries within eight hours, participating in team collaboration to maximize reimbursement, and escalating coding principle discrepancies to supervisors immediately.
• Coders must check Guidehouse email every two hours during work sessions, adhere to division policies and procedures, and contribute to team efficiency by supporting accurate, timely, and compliant coding operations.
• This role offers the opportunity to deepen expertise in HCC risk adjustment, annual wellness visits, and evaluation & management coding while working with diverse healthcare data across multiple specialties and payer types.
• The coder will gain experience in resolving payer denials, understanding CMS HCC models (including ESRD, PACE, RX, CDPS, and HHS variants), and contributing to audit readiness and regulatory compliance initiatives.
• Working remotely for a national consulting firm like Guidehouse provides exposure to enterprise-level coding standards, cross-functional collaboration, and opportunities for professional growth in healthcare analytics and compliance.

🎯 Requirements

• High School Diploma or equivalent
• 3+ years of HCC Risk Adjustment Coding experience
• Current CPC or CRC certification from AAPC, which must be maintained throughout employment
• Proven EMR (Electronic Medical Records) experience
• Strong working knowledge of federal and state coding regulations and official coding guidelines (ICD-10-CM, CPT, HCPCS)

🏖️ Benefits

• Comprehensive medical, prescription, dental, and vision insurance
• 401(k) retirement plan with potential employer match
• Tuition reimbursement, personal development, and skills certification opportunities
• Parental leave, sick time, company-paid holidays, and short- & long-term disability coverage
• Health Savings Account (HSA), FSA for dependent care, and life insurance options
• Employee referral program, corporate events, community outreach, and emergency backup childcare support

Skills & Technologies

Remote

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Guidehouse Inc.

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About Guidehouse Inc.

Guidehouse Inc. is a global consulting and managed services provider formed in 2018 from the public sector practice of PwC. The company advises public and commercial clients on strategy, technology, risk management, and operations, focusing on energy, financial services, health, defense, and cybersecurity. With 18,000 professionals in over 60 offices worldwide, it delivers implementation support, managed services, and digital solutions to federal agencies, utilities, and Fortune 500 organizations. Guidehouse is majority-owned by Veritas Capital and partners with governments and businesses to address complex regulatory, operational, and innovation challenges.

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