Become a Certified Risk Adjustment Coder in Tennessee: Your Guide to Success

To secure the title of certified risk adjustment coder in Tennessee, precise coding knowledge and a solid grasp of the healthcare payment system are essential. This guide provides a clear map to certification—covering educational paths, exam prep, and career benefits—helping you step confidently into this vital healthcare field.

Key Takeaways

  • Certified Risk Adjustment Coders are vital in the healthcare industry, requiring a deep understanding of medical coding, regulations, and audit processes to ensure accurate coding for reimbursement models and patient care quality.
  • Becoming a Certified Risk Adjustment Coder in Tennessee entails completing relevant education programs or acquiring practical coding experience, preparing for and passing certification exams through AAPC or other bodies, and a recommended foundation in health information management.
  • With opportunities for continuing education, professional networking, and a positive career outlook—including competitive salaries and job stability—certification as a Risk Adjustment Coder promises a fulfilling career in Tennessee’s healthcare coding sector.
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Exploring the Role of a Certified Risk Adjustment Coder

Certified Risk Adjustment Coder in Tennessee

A Certified Risk Adjustment Coder carries the mammoth task of scrutinizing and assigning accurate medical codes for diagnoses from various healthcare providers, including inpatient hospital settings. This role requires a deep understanding of medical coding guidelines, regulations, and compliance, with a specific focus on the implications of diagnosis coding on risk adjustment payment models and quality risk adjustment coding.

Specialized in the audit process of risk adjustment models, these coders are proficient in:

  • Reporting documentation deficiencies to providers, thereby improving the accuracy of risk adjustment coding
  • Acquiring knowledge of anatomy, pathophysiology, and medical terminology to correctly code diagnoses
  • Understanding the financial implications of risk adjustment coding
  • Understanding the audit process and the impact of diagnosis coding on risk adjustment payments

Their expertise goes beyond regular coding and their training covers all these aspects.

Understanding Risk Adjustment Models

Risk Adjustment Models Calculation

Quality risk adjustment is a crucial mechanism in the healthcare industry, as risk adjustment relates to calculating payments to healthcare providers, taking into account the patient’s health status and probable use of healthcare services. The ultimate goal? To ensure equitable payment for providers, offering higher reimbursements for treating patients with complex health needs. A risk adjustment survey can be a valuable tool in this process.

Organizations like the CMS Innovation Center utilize varying risk adjustment models for establishing financial benchmarks in models that influence Medicare payments to healthcare providers. This shifts the payment structure from a service-based to a patient-based approach. To ensure precision, risk adjustment models are consistently evaluated and updated to accurately represent the changing health needs and statuses of patients.

Importance of Accurate Diagnosis Coding

Accurate Diagnosis Coding Importance

Accurate diagnosis coding plays a pivotal role in the risk adjustment process. It determines the risk score based on a patient’s demographics and health status, which is crucial in estimating future healthcare costs and resource needs for reimbursement. ICD-10-CM codes are integral to risk adjustment models as they provide essential data about a patient’s health status, significantly impacting the calculation of accurate reimbursement for healthcare services.

However, inaccurate or inconsistent diagnosis coding can lead to improper risk score assessment, potentially resulting in financial inaccuracies such as overpayment or underpayment for health services rendered to patients. Beyond ensuring appropriate reimbursement, accurate diagnosis coding is vital for truly reflecting a patient’s health condition, including nutritional and metabolic diseases, which supports the provision of quality patient care.

Pathway to Becoming a Certified Risk Adjustment Coder in Tennessee

Pathway to Becoming a Certified Risk Adjustment Coder

Embarking on a journey to become a risk adjustment coder requires a strong foundation in medical coding concepts and guidelines. Medical coding training programs that focus on practical diagnosis coding skills are crucial for this specialized field. Moreover, gaining hands-on training or experience is highly beneficial in grasping the nuances of medical coding and risk adjustment.

Practical experience in coding, particularly within the healthcare field, is significant for prospective risk adjustment coders. Candidates for CRC certification should ideally have at least two years of experience in medical coding or a related field, showcasing their fundamental medical coding skills.

Preparing for the CRC exam involves:

  • studying a range of materials, including the ICD-10-CM code set
  • taking practice exams to evaluate readiness
  • engaging in dedicated study sessions using comprehensive CRC exam preparation materials

This is key to passing the exam.

Educational Requirements and Training Programs

While an associate’s degree is not mandatory for medical coding certification, it is recommended. Health information management degrees can set the foundation for a career in medical coding. The AHIMA Certified Coding Associate (CCA) certification does not have mandatory prerequisites, but there are certain recommended basic courses to enhance a coder’s foundational knowledge.

In addition to this, the University of Tennessee at Chattanooga offers an 18-week online Medical Billing and Coding Academy that prepares students for the AAPC CPC certification exam with 80 hours of coursework. Completing the UTC program grants students a 1-year AAPC membership, required coding textbooks, a medical terminology book, an anatomy eBook, the official CPC exam study guide, and an opportunity for a free retake of the CPC certification exam. The AAPC’s CRC training course, suitable for those with at least two years of experience, covers essential topics such as medical terminology, anatomy, and pathophysiology, and can lead to CRC certification.

To attain the AHIMA Certified Coding Specialist (CCS) credential, candidates need to complete educational courses in advanced/intermediate CPT and ICD-10 coding, insurance reimbursement, and medical sciences. Tennessee provides a range of educational options for aspiring coders, from specialized online certification programs to comprehensive academic degree programs.

Certification Process and Exam Preparation

AAPC offers a Certified Risk Adjustment Coder (CRC)® Online Training Course that includes online practice exams and Practicode CRC Practicum, allowing hands-on practice with real-world coding cases. Training directly with AAPC for risk adjustment coding equips coders with a curriculum trusted by the creators of the certification exams.

Becoming a Certified Risk Adjustment Coder (CRC) is achievable by either completing a program in risk adjustment coding or accumulating two years of related professional experience. Earning the CRC credential through AAPC’s certified course also provides 30 Continuing Education Units (CEUs) necessary for maintaining the certification. AAPC offers the flexibility of taking the exam online with a live remote proctor or at a physical testing center, catering to various personal circumstances.

Career Outlook and Opportunities in Tennessee

Completion of the CRC training course by AAPC can affirm a coder’s experience to employers and help differentiate them as a certified risk adjustment coder in Tennessee. As a certified risk adjustment coder, you are not just embarking on a rewarding career path, but you’re also setting yourself up for a future filled with opportunities.

Salary Expectations and Job Security

Let’s talk numbers. The average hourly pay for a risk adjustment coder at Blue Cross BlueShield of Tennessee ranges from $27 to $38, with a base salary of approximately $31 per hour. But that’s not all. In addition to the base salary, risk adjustment coders at Blue Cross BlueShield of Tennessee may receive additional pay in the form of:

  • Cash bonuses
  • Stock
  • Commission
  • Profit sharing
  • Tips

These financial benefits, including a competitive hourly rate and diverse additional pay options, contribute to the job stability of certified risk adjustment coders in the health sector, which can be considered as one of the factors influencing health status.

Enhancing Your Expertise in Risk Adjustment Coding

Continuing Education in Risk Adjustment Coding

Advancing in your career as a certified risk adjustment coder involves more than just gaining initial certification. Clinical documentation improvement programs are essential for bridging the gap between clinical care and documentation specificity, crucial for accurate risk adjustment coding. To determine documentation barriers encountered, it’s important to continuously evaluate and refine your coding skills, including the analysis of medical record operative reports.

This involves continuing education, professional development, and networking through organizations like AAPC and AHIMA.

Continuing Education and Professional Development

To maintain the Certified Risk Adjustment Coder (CRC) credential, coders must earn 36 continuing education units (CEUs) every two years. The continuing education requirements depend on the number of credentials held and are established by professional organizations like AAPC and AHIMA, with AAPC’s criteria varying by certificate and AHIMA requiring 20 CEUs for certain certifications during each certification cycle.

AAPC requires CRC credential holders to actively maintain their annual membership in addition to meeting the CEU requirements to retain their certification. AHIMA provides its Premier members with free learning opportunities that award eight CEUs annually for professional development.

Networking and Professional Organizations

Professional organizations such as AAPC and AHIMA offer vast networking opportunities that are crucial for career growth in the field of risk adjustment coding. Some benefits of joining these organizations include:

  • Access to a wide range of networking options
  • Educational workshops and events specifically geared towards certified risk adjustment coders
  • Membership in a global community, enabling networking and the exchange of valuable insights among health information professionals.

Members of AHIMA benefit from special discounts on services such as travel, entertainment, and insurance, along with preferred pricing on its products that support both personal and professional development in the health and human services field, including hospital and provider services.

Resources and Support for Tennessee Coders

Tennessee’s community colleges have student advising teams dedicated to supporting students in medical coding programs. Local workforce development boards in Tennessee offer career advice, job placement assistance, and other resources for coders seeking employment. Coders have access to external professional organizations and support groups, such as the AAPC local chapters, which provide networking opportunities and information sessions. State funding programs like the Tennessee Reconnect and the Tennessee Promise are available to assist students with the costs related to medical coding training.

Career services centers at educational institutions in Tennessee offer guidance tailored to medical coders, including resume advice, interview preparation, and job search strategies.

Financial Assistance and Scholarships

The Tennessee Promise scholarship offers last-dollar scholarships to high school graduates in Tennessee. It covers tuition and fees at community or technical colleges that are not met by the Pell Grant, HOPE scholarship, or TSAA funds. To be eligible for Tennessee Promise, students must:

  • Apply in their senior year of high school
  • Complete community service hours
  • Maintain satisfactory academic progress
  • Utilize the resources of a mentor provided by the program.

Federal and state financial aid, including grants, loans, and work-study programs, are accessible to Tennessee students when they complete the FAFSA, starting October 1st each year. Specialized scholarships for medical billing and coding students provide varying financial support amounts that do not require repayment. Medical coding students can participate in work-study programs, enabling them to work in relevant jobs on or near campus as a way to support their education financially.

For additional financial aid options, students can refer to the National Association of Student Financial Aid Administrators’ website, which offers information on state-specific aid for Tennessee residents.

Accessing Quality Instructional Materials

AHIMA’s Premier membership includes access to toolkits that are essential for risk adjustment coders engaging in both certification preparation and continuous learning. Accredited programs recommend a variety of online resources and textbooks that are useful for risk adjustment coders in preparing for certification exams and ongoing professional development.

The State Textbook and Instructional Materials Quality Commission in Tennessee ensures that medical coding textbooks conform to education standards and are accurately vetted by an advisory panel before being recommended.


In conclusion, becoming a Certified Risk Adjustment Coder in Tennessee is an exciting journey filled with learning, challenges, and growth. From understanding the role and significance of risk adjustment coding to exploring the pathway to certification and career opportunities, this rewarding career path offers an integral role in the healthcare industry. By continuing your education, leveraging networking opportunities, and accessing the wealth of resources available, you can make a significant impact in the field of risk adjustment coding.

Frequently Asked Questions

How do I become a certified risk adjustment coder?

To become a certified risk adjustment coder (CRC), you need to complete CRC training, pass the CRC certification exam, and meet any additional accreditation requirements. The American Association of Professional Coders recommends earning an associate degree in medical coding as well.

How hard is the CRC exam?

The CRC exam can be demanding, but not difficult if you have taken the training course, studied, and are familiar with your ICD-10-CM code book.

Which is better CPC or CRC?

Choosing between CPC and CRC depends on your coding goals. The CRC is generally recommended as it is less challenging, but make the decision based on your specific needs.

What is a CRC coder?

A CRC coder, or Certified Risk Adjustment Coder, is responsible for accurately assigning diagnosis codes for risk adjustment models, contributing to optimal patient care and ethical payer reimbursement for providers and health plans.

What is the role of a Certified Risk Adjustment Coder?

The role of a Certified Risk Adjustment Coder is to review and accurately assign medical codes for diagnoses, particularly in inpatient hospital settings, and to contribute to the audit process of risk adjustment models. This helps improve the accuracy of risk adjustment coding.