• Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate • Offer suggestions and assistance for improvement in departmental processes & other duties as assigned • Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture • Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of Identifying and validating reported diagnoses for Medicare/Medicare Advantage and ACO health plan members • Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented • Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy, Completeness, specificity and appropriateness of diagnosis information • Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality • Maintains established work production standards • Assumes responsibility for professional growth and development • Participates in professional healthcare and community associations to keep abreast of current healthcare trends