11 certified risk adjustment coder jobs found

Astrana Health, Inc. is looking for a Risk Adjustment Coding Specialist II to support high-volume coding efforts in Orange County. This full-time position offers opportunities to analyze data and educate providers, requiring travel up to 75% of the time. The ideal candidate should have significant experience in risk adjustment coding, critical presentation skills, and a valid driver's license. Compensation ranges from $70,000 to $85,000 per year, depending on experience and location. #J-18808-Ljbffr

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This is a remote position. The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of...

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to join the Quality - Risk Adjustment team in Orange, CA. The role requires expertise in Medicare Advantage, ACA, and commercial risk adjustment coding, with significant travel to provider sites to support coding education and standards. The ideal candidate will hold CCS/CPC (AAPC/AHIMA) certification, have 3+ years of risk adjustment experience, and be proficient with EHR and coding software. #J-18808-Ljbffr

Alignment Health is seeking a qualified MRA Coding Auditor to support QA audits of internal coding teams and vendors. The role ensures accurate data submissions to CMS and supports risk adjustment audits, including RAF, prevalence, and documentation improvement. Candidates should have CCS/CCP/CPC and at least three years in Medicare risk adjustment coding. The position emphasizes data integrity, compliance with HIPAA, and ongoing professional development within a fast-growing team dedicated to #J-18808-Ljbffr

Humana Inc. is seeking a Risk Adjustment Coding Professional to perform quality assurance audits of medical records and CMS/ICD-9/10 codes on a remote, nationwide basis. You will ensure coding accuracy is supported by clinical documentation and align with regulations and company guidelines. This role requires CPC/CCS/CCA, 3 years of risk adjustment coding experience, proficiency in MS Office, and strong collaboration skills; overtime and occasional travel to training may apply, with flexible #J-18808-Ljbffr

Your job is more than a job The Coding Specialist I will be responsible applying the appropriate ICD-10-CM/PCS and CPT (charging) diagnostic and procedural codes for outpatient and/or inpatient encounters, ancillary encounters ambulatory/ provider based clinics. GENERAL DUTIES Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APCs, CPT/HCPCs assignment and all required modifiers. Validates charges by comparing charges with health record documentation as necessary. Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist regarding documentation issues or needs related to Inpatient, Outpatient, or Ambulatory coding. Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems. Tracks issues (i.e. missing documentation, charges and physician...

Astrana Health is seeking a Risk Adjustment Coding Specialist to support Medicare Advantage, ACA, and Commercial coding initiatives. The role reports to the Sr. Manager - Risk Adjustment and requires frequent travel to provider sites. Strong collaboration with physicians and staff is essential to ensure CMS guidelines are followed. Responsibilities include reviewing records for HCC coding, conducting audits, training staff, and providing process improvements. #J-18808-Ljbffr

Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. Join a forward-thinking team where your expertise drives quality patient care! We are looking for a detail-oriented Professional Medical Coder to help streamline our charge review coding workflow for Adult and Pediatric Evaluation and Management services and Minor Procedures, resolve denials and work with leadership to put processes in place to reduce denials. Enjoy flexible remote / hybrid options, continuous career development, and competitive compensation in a supportive environment. General Description Independently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement, wRVU integrity, and audit...

Must have Prospect coding experience on resume Job Description: This role supports an ongoing Medicare and Medicare Advantage risk adjustment initiative, focused on validating diagnosis codes to the highest level of specificity. The position involves high-volume chart review using the Innovaccer platform, with no defined end date and long-term project stability. Responsibilities: Audit information pulled by the Innovaccer tool and validate diagnosis codes for accuracy and specificity Review supporting medical documentation and make final determinations prior to provider review Perform high-volume reviews with expected daily productivity of 50–80 charts Focus exclusively on Medicare and Medicare Advantage (MA) populations Utilize coding and EMR systems including 3M, Epic, Athena, and Cerner Ensure coding accuracy and compliance with risk adjustment and outpatient coding guidelines Requirements: Minimum of 1 year of experience in risk adjustment coding, HCC coding, or outpatient...

NKC Health has a need for a Certified Coder to join our team! If you're looking for a great opportunity to serve our community and be part of a growing team, join our NKC Health family where there is more for you! Here at NKC Health, as part of the coding team, you will have the opportunity to focus solely on coding processes. Your daily mission would be to review medical records for the correct ICD/CPT codes, posting charges and having meaningful communication with the practice team. Reasons to Join NKC Health: Comprehensive Benefits (Medical, Dental, Vision, Life, FSA) Employer matched retirement plan Competitive wages Paid time off for personal/vacation/sick Six paid holidays per year Educational assistance Day shift schedules Job Responsibilities: Review procedures, HCPCS, and diagnosis coding for accuracy. Assigns proper codes based upon medical record documentation. Works with denials team and central billing office to resolve claims...

*Job Description* The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. *Your Responsibilities* * Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices * Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements * Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting * Verifies and ensures the accuracy, completeness, specificity and appropriateness of...