Risk Adjustment Coder

Location: Baton Rouge, LA 70809
Contract Length: 4 Months

Position Summary

We are seeking an experienced Risk Adjustment Coder with a strong background in Medicare Advantage Risk Adjustment and ACA Risk Adjustment coding. This position supports ongoing risk adjustment initiatives through accurate coding, medical record review, documentation validation, and quality assurance activities.

The coder will help ensure compliance with CMS and other regulatory requirements while supporting risk adjustment accuracy and revenue integrity goals. Candidates should have demonstrated experience with CMS-HCC coding methodologies, medical record review, and risk adjustment documentation validation.

This position works under general supervision and does not have direct supervisory responsibilities.

Key Responsibilities

• Review and assess medical record documentation and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs.

• Perform retrospective and prospective coding reviews to identify supported HCC conditions.

• Evaluate medical records for coding accuracy, completeness, and compliance with CMS Risk Adjustment guidelines.

• Conduct quality assurance reviews and coding audits to ensure coding accuracy and regulatory compliance.

• Identify coding trends and provide feedback regarding documentation improvement opportunities.

• Support risk adjustment data validation, chart review, and audit initiatives.

• Collaborate with business partners and stakeholders to support risk adjustment and coding accuracy goals.

• Maintain productivity and quality standards while meeting established deadlines.

• Assist with gap identification and closure initiatives for Medicare and ACA populations.

• Document coding results in designated systems and maintain accurate records.

• Perform other duties as assigned.

Required Qualifications

Education

• High School Diploma or GED required.

Experience

• Minimum of 3 years of medical coding experience.

• Strong Medicare Advantage Risk Adjustment coding experience required.

• Experience with CMS-HCC coding methodologies and risk adjustment programs.

• Experience performing medical record reviews and coding validation activities.

• Experience interpreting clinical documentation and assigning accurate ICD-10-CM diagnosis codes.

• Ability to work independently in a remote environment while maintaining productivity and quality expectations.

Preferred Qualifications

• ACA Risk Adjustment coding experience.

• CRC, CPC, CCS, RHIT, RHIA, or similar coding certification.

• Experience conducting coding audits and quality assurance reviews.

• Experience supporting Risk Adjustment Data Validation (RADV) audits.

• Experience within a managed care, health insurance, or Medicare Advantage environment.

Knowledge, Skills, and Abilities

• Advanced knowledge of ICD-10-CM coding guidelines.

• Strong understanding of Medicare Advantage Risk Adjustment and HCC coding methodologies.

• Working knowledge of ACA Risk Adjustment principles.

• Strong analytical and problem-solving skills.

• Excellent attention to detail and organizational skills.

• Ability to interpret complex clinical documentation.

• Strong written and verbal communication skills.

• Intermediate proficiency with Microsoft Office applications.

• Experience working with Electronic Medical Record (EMR) systems.

• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

STRATEGIC STAFFING SOLUTIONS HAS AN OPENING!

This is a Contract Opportunity with our company that MUST be worked on a W2 Only. No C2C eligibility for this position.

“Beware of scams. S3 never asks for money during its onboarding process.”

Job Title: Benefits & Claims Representative
Location: Baton Rouge, LA 70809
Work Schedule: Remote – 100% onsite for training; may be required onsite several times per month
Contract Length: 6 Months

Job Ref # 247880

Required Qualifications

Experience

• 1+ year of customer service or medical office experience
• OR completion of BRCC Medical Assistant, Coding & Insurance pathway in lieu of experience

Education

• High School Diploma or equivalent

Additional Requirements

• Strong verbal and written communication skills with professionalism and empathy
• Ability to interpret and explain benefits, claims, and policies clearly
• Critical thinking and problem-solving skills
• Ability to multitask and manage multiple inquiries in a fast-paced environment
• Attention to detail and organizational skills
• Conflict resolution and ability to remain calm under pressure
• Active listening and effective questioning skills
• Proficiency in Microsoft Office and related systems
• Must live within 45 miles of Baton Rouge, LA
• Must have broadband internet service at home
• AT&T Air and T-Mobile 5G internet are not compatible with required equipment
• Must successfully complete customer service training and demonstrate proficiency

Preferred Qualifications

• Call center experience
• Familiarity with healthcare/insurance terminology

Responsibilities

• Resolve benefit and claims inquiries from members and providers via telephone and other approved channels
• Handle inbound inquiries related to benefits, claims, billing, and eligibility
• Research and resolve customer issues across multiple systems to ensure accuracy of benefits and payments
• Respond to inquiries regarding adjustments, refunds, and payment discrepancies
• Maintain up-to-date knowledge of policies, procedures, and regulatory requirements
• Document interactions and ensure completeness and accuracy of information
• Meet established customer service performance metrics, including quality, productivity, customer satisfaction, and attendance
• Demonstrate ownership of issues and drive First Call Resolution (FCR)
• Work in a high-volume call center environment, with approximately 95% of time spent on the phone
• May be required to work during emergencies or inclement weather
• Perform other duties as assigned within scope

STRATEGIC STAFFING SOLUTIONS HAS AN OPENING!

This is a Contract Opportunity with our company that MUST be worked on a W2 Only. No C2C eligibility for this position. Visa Sponsorship is Available! The details are below.

“Beware of scams. S3 never asks for money during its onboarding process.”

Job Title: Claims Specialist
Remote Work
Contract Length: 5 Months

Job Ref #: 247717

The Claims Specialist will support claims operations by accurately processing claims edits, determining primacy for Coordination of Benefits, adjusting previously paid claims, and initiating procedures to recover funds on overpaid claims. This position will analyze, investigate, and resolve problem cases, execute recovery processes, and complete special projects while complying with applicable laws and regulations.

Required Qualifications

• High school diploma or equivalent
• At least 2 years of medical claims-processing experience
• Strong analytical ability, including logical, systemic, and investigative thinking
• Strong oral and written communication skills
• Strong human-relations skills
• Working knowledge of relevant PC software
• Ability to prioritize multiple streams of work effectively

Preferred Qualifications

• Coordination of Benefits processing experience
• Hands-on experience determining which insurance plan pays first when a member has multiple sources of coverage
• Experience identifying primary and secondary coverage
• Experience reviewing and updating claims based on COB rules
• Experience applying COB primacy rules, including subscriber status, effective dates, plan type, and Medicare coordination
• Experience communicating with members, providers, and other insurers to verify coverage information
• Experience correcting overpayments, initiating refunds or reprocessing claims, and maintaining accurate claim records
• Experience working within claims systems and following regulatory and compliance requirements, including HIPAA

Responsibilities

• Review, research, and update claims, including recalculating benefits on previously processed claims
• Process claims edits according to contractual benefits and provider-reimbursement rules
• Initiate refund requests when necessary
• Identify denial codes, edits, and processing codes associated with coordinated and non-coordinated claims
• Request medical records when required
• Communicate orally and in writing with internal and external contacts to establish accurate claims records
• Review quality audits for correction or routing within 48 hours of receipt
• Research and determine the correct order of benefits for payment by applicable plans
• Make necessary corrections to COB records
• Notify the appropriate departments when Medicare has determined primacy incorrectly
• Analyze, investigate, and resolve problem cases involving COB records, adjusted claims, and overpayments
• Review previously processed claims to ensure payment consistency and maximize overpayment recovery
• Execute procedures to recover funds from providers, subscribers, or beneficiaries when overpayments occur
• Support training, implementations, documentation, and special projects
• Assist with matters involving internal-audit findings, provider-status changes, and system errors
• Perform other job-related duties within the scope of the position

Job Title: Provider Dispute Intake Coordinator

Duration- 6 Months

Onsite position – with an opportunity for Hybrid (3days onsite – 2 days remote) after training period

Pay- $20/hr

 

Position Summary

The Provider Dispute Intake Coordinator plays a key role in supporting the Provider Disputes team by managing the intake, tracking, and distribution of provider disputes, appeals, and related correspondence. This position ensures that all incoming cases are accurately recorded, prioritized, and assigned for timely review and resolution.

This role also provides administrative and clerical support to the department, helping maintain compliance with regulatory requirements and internal policies while supporting efficient claims processing and communication across teams.

Key Responsibilities

• Review processed claims to identify valid provider disputes
• Create and assign dispute cases within EPIC to Provider Dispute Specialists
• Coordinate intake, tracking, prioritization, and distribution of incoming disputes, appeals, and correspondence
• Maintain accurate records of case flow and ensure timely routing to appropriate teams or individuals
• Assist leadership with administrative tasks, reporting, and file maintenance
• Prepare materials for appeal reviews, including case documentation, binders, and communications
• Ensure all documentation complies with privacy regulations and internal policies
• Forward medical appeals, FEP appeals, and correspondence to appropriate departments in a timely manner
• Support internal coordination by following up with staff and departments to ensure timely claims processing and resolution
• Maintain electronic and physical filing systems and update dispute tracking databases
• Generate reports for internal meetings and ad hoc requests
• Monitor and maintain office supply inventory and related documentation
• Navigate systems such as Facets and Jiva to review claims and authorizations
• Perform other administrative and departmental duties as assigned

Qualifications

Education

• High School Diploma or equivalent required

Experience

• Minimum of 2 years of experience in a medical or insurance office setting
• Experience with claims processing or provider/member services required
• Familiarity with healthcare systems such as Facets and EPIC preferred

Skills & Competencies

• Strong organizational and time management skills
• Ability to prioritize and manage multiple tasks in a fast-paced environment
• Attention to detail and accuracy in data entry and documentation
• Proficiency in Microsoft Office (Word, Excel, PowerPoint)
• Strong communication and coordination skills
• Ability to handle sensitive information in compliance with privacy regulations

Work Environment

• Office-based role in a professional, low-noise environment
• Work is primarily performed while sitting or standing at a desk
• Requires the ability to analyze, document, and manage detailed information

Reporting Structure

• Reports to: Supervisor, Provider Disputes
• This position does not have direct reports

Why Join Us

You’ll be part of a collaborative team that plays a critical role in ensuring accurate claims handling and provider satisfaction. This position offers an opportunity to build expertise in healthcare operations, claims processing, and dispute management within a supportive environment.