Certified Risk Adjustment Coders (CRCs) play a critical role in establishing accurate risk scores for patients, which promotes optimal patient care and ethical payer reimbursement for providers and health plans.

Where do risk adjustment coders work?

And risk adjustment and HCC coders typically work for the insurance plan, usually, whether they work directly for the insurance plan as a subcontractor for a company working for the health insurance plan.

What is the ultimate goal for risk adjustment coders?

The primary goal of risk adjustment is to provide appropriate funding to health plans to cover the expenses of their enrollees and to discourage incentives for health plans to selectively enroll healthier members. It is intended to provide an environment where health plans compete on quality and efficiency.