The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines. Reviews claims, requests additional information, and initiates claim investigations. Maintains production and quality standards and participates in training.

This role is a unique opportunity for an experienced medical coder with robust risk adjustment auditing experience. You will review medical records, prepare audit results reports, and provide coding insights to Fathom engineering and client success teams to accelerate product development. You should have a current AAPC CRC certification or AHIMA RAC microcredential.

Complete first past reviews of member medical records to capture active conditions that map to a risk value. Maintain compliance with CMS risk adjustment diagnosis coding guidelines. Assist with the intake and quality assurance of medical records as necessary. An assessment is required for this role.