Certified Coding Specialist Risk Adjustment Expert
Resume:
M A R C U S R. H A M I L T O N
CERTIFIED CODING SPECIALIST
909-***-**** ********@*****.*** Fontana, CA 92335
Certified Coding Specialist (CCS) since 2018 with proven expertise in ICD-10-CM,PCS,CPT and HCPCs coding. Highly organized and detail-oriented, with strong communication, time management, and analytical problem-solving skills. Collaborative and motivated professional committed to accuracy, compliance, and excellence in medical coding.
SKILLS
● Medical Coding
(ICD-10-CM, ICD-10-PCS, CPT, HCPCS)
● Risk Adjustment Coding
(HCC, CMC-HCC, HHS-HCC)
● Medicare Advantage (MA) and ACA chart
proficient
● Concurrent & Retrospective Chart Review
● Medical Records Abstraction &
Documentation
● High Coding Accuracy & Productivity
● Proficient in Microsoft Excel &
EHR Systems
● Identifies Documentation Gaps & Coding
Opportunities
● Strong Communication & Team
Collaboration
● Medical Terminology & HIPAA Compliance
● Detail-Oriented & Audit-Ready
PROFESSIONAL EXPERIENCE
Senior Risk Adjustment Coding Specialist, Robert Half (HealthRecon Connect) Dec. 2025 - present
● Manage Inpatient coding processes for a 60-bed facility, analyzing medical documentation and assigning ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes to support accurate billing and compliance.
● Review and audit AI-assisted charts to ensure documentation accuracy and adherence to internal standards.
● Utilize appropriate software tools to validate and group codes for reimbursement purposes.
● Address missing or unclear information by submitting a query to the provider.
Senior Risk Adjustment Coding Specialist, Weller Hit (Reveleer) May 2025 - Oct 2025
● Responsible for validating and reviewing Hierarchical Condition Category (HCC) risk adjustable charts through retrospective and concurrent chart reviews.
● Reviewed and audited AI-assisted and administrative charts to ensure documentation accuracy and adherence to internal standards.
● Applied clinical documentation standards and industry guidelines to support coding decisions.
● Contributed to audit accuracy, process improvements, and helped maintain compliance with state/federal regulations and internal policies.
Senior Risk Adjustment Coding Specialist, UnitedHealth Group (CHPW) Mar 2023 - Dec 2023
● Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations using current CPT-4, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials.
● Performed retrospective and concurrent coding vendor quality review audits to validate correct ICD-10-CM code assignments and looked for missed codes for risk adjustment.
● Conducted chart reviews and validation in support of HHS RADV (Risk Adjustment Data Validation) audits.
● Performed vendor audits to ensure compliance with CMS, HHS, and Medicaid risk adjustment guidelines.
HCC Medical Coder, Oscar Health Mar 2021 - Jan 2023
● Maintained compliance with national standards and coding practices set by the ICD-10-CM guidelines for accuracy and production standards.
● Coded Medicare Advantage (MA) and Affordable Care Act (ACA) charts
● Responsible for daily operations pertaining to Risk Adjustment including but limited to : medical records reviews, potential CMS audits and medical record retrieval efforts.
● Developed relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
● Utilized multiple Electronic Medical Record (EMR) systems, including AthenaOne, Cerner, and Epic, to review and manage patient data.
HCC Risk Adjustment Coder, Insight Global (Optum Care) Aug 2020 - Mar 2021
● Coding HHS-HCC and CMS-HCC model charts
● Performed chart reviews which include coding, abstracting and house calls. Analyze Hospital and physician base, ER, inpatient and outpatient medical records.
● Demonstrated expertise in the requirements and parameters of mandated HEDIS performance measures.
● Developed relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
● Reviewed and compared data abstracted from medical records by third-party vendors with the appropriate measure guidelines.
HCC Medical Coder, AE & Associates, LLC Dec 2018 to Jun 2020
● Reviewed provider documentation and assigned ICD-10 diagnosis codes for inpatient and outpatient facility services.
● Utilized ICD-9-CM, ICD-10-CM, and CPT coding systems to support accurate billing and regulatory compliance.
● Consistently processed 4–5 charts per hour while maintaining coding accuracy.
● Demonstrated strong time management and accountability in a remote work setting.
● Rapidly reached 95% productivity benchmark and sustained consistent output.
● Ensured 90% accuracy rate across all completed work.
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