Medical Coder Risk Adjustment

Position: Medical Coder Risk Adjustment Only
Medical Coder – Risk Adjustment (RADV Audit Specialist) Chennai (Hybrid)

Experience:

4–5 Years
Invent Health Inc

Invent Health is a Silicon Valley–based healthcare analytics company focused on Risk Adjustment, Coding Intelligence, and NLP-powered chart review solutions. We support leading U.S. health plans across Medicare Advantage, Medicaid, and ACA, processing over 5.5M+ member lives annually.
We are expanding our Chennai team and hiring an experienced  Risk Adjustment Medical Coder with strong RADV audit expertise  who is comfortable working in a technology-enabled coding environment.

Role Overview This role requires deep expertise in risk adjustment coding and RADV audit validation. You will work extensively on  Invent Health’s proprietary NLP-powered Coder Workbench , leveraging AI-assisted insights while applying your clinical judgment to ensure CMS-compliant, audit-ready coding.
This is NOT a traditional manual coding role — we are looking for coders who can effectively use intelligent tools and maintain high accuracy under audit scrutiny.

Key Responsibilities
• Perform detailed chart reviews for Medicare Advantage (CMS-HCC V24 & V28) and applicable LOB's.

• Conduct RADV-level validation and documentation review

• Validate HCC capture, deletions, and documentation support

• Ensure adherence to CMS guidelines, ICD-10-CM Official Guidelines & MEAT criteria

• Work extensively within IH’s proprietary NLP-enabled Coder Workbench

• Review and validate NLP-suggested codes with high precision

• Identify unsupported diagnoses and documentation gaps

• Support internal QA and audit preparedness initiatives

• Analyze coding trends and contribute to quality improvement efforts

• Maintain strict HIPAA & PHI compliance

Required Qualifications
• 4–5 years of Risk Adjustment Coding experience (Medicare Advantage mandatory)

• Hands-on RADV audit experience

• Strong understanding of CMS-HCC model (V24; V28 knowledge preferred)

• Active certification: CRC / CPC / CCS (CRC preferred)

• Strong knowledge of:
– RADV medical record validation
– MEAT criteria
– ICD-10-CM Official Guidelines
– CMS documentation standards

• Comfortable working in AI/NLP-assisted coding platforms

• Experience reviewing large medical records (100+ page charts)

• Strong analytical and documentation interpretation skills
Preferred
• Experience with technology-enabled coding platforms or coder workbench tools

• Exposure to QA frameworks and second-level audit reviews

• Experience supporting U.S. health plans

• Understanding of encounter data submission (837 exposure is a plus)