475 clinical risk adjustment coder jobs found

Clinical Risk Adjustment Coder Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines. Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models. Conduct in-home or virtual health assessments with patients, evaluating and...

Clinical Risk Adjustment Coder Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines. Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models. Conduct in-home or virtual health assessments with patients, evaluating...

Clinical Risk Adjustment Coder Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines. Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models. Conduct in-home or virtual health assessments with patients, evaluating...

Clinical Risk Adjustment Coder Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines. Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models. Conduct in-home or virtual health assessments with patients, evaluating and...

Are you looking to work for a company that has been recognized for over a decade as a Top Place to Work? Apply today to become a part of a company that continues to commit to putting our employees first. Job Description: About Alpine Physician Partners Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. Position Summary The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding...

Clinical Risk Adjustment Coder Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines. Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models. Conduct in-home or virtual health assessments with patients, evaluating...

City/State Doral, FL Work Shift First (Days) Overview: AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA in Doral, FL! Status: Full-timepermanent position (40 hours) Standard working hours: 8am to 430pm EST, M-F Location: This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary Then Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for...

City/State Doral, FL Work Shift First (Days) Overview: AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA in Doral, FL! Status: Full-timepermanent position (40 hours) Standard working hours: 8am to 430pm EST, M-F Location: This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary Then Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's...

Job PostingOct 5, 2026 Risk Adjustmt Coder Educator / Clinical IntegrationDescriptionWork where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. Position Summary: The Risk Adjustment Coder Educator develops and implements an enterprise-wide risk adjustment coding and documentation education...

Hartford HealthCare at Home seeks a Risk Adjustment Coder Educator to develop and implement enterprise-wide coding education ensuring CMS compliance and accurate ICD-10 coding across contracted providers. Responsibilities include leading complex training programs, delivering education in various settings, and driving improvements in documentation and data capture for Medicare Risk Adjustment. On-site visits in Connecticut required. #J-18808-Ljbffr

Insight Global is seeking Medical Coders specializing in Risk Adjustment Coding for a leading healthcare client. These professionals will review medical records and clinical documentation to accurately assign ICD-10-CM diagnosis codes that support risk adjustment and HCC reporting. Ideal candidates will have strong experience with medical record review, coding compliance, and CMS guidelines, ensuring all diagnoses are fully supported by clinical evidence. Remote work options are available. #J-18808-Ljbffr

Required Skills & Experience Certified coder (CPC, CCS, CRC, CCA, or equivalent certification) Strong ICD-10-CM coding experience and medical record review background Knowledge of Risk Adjustment and HCC coding methodologies Experience reviewing physician documentation and assigning accurate diagnosis codes Strong understanding of medical terminology, anatomy, physiology, and disease processes Ability to interpret complex clinical documentation with high accuracy and productivity Familiarity with CMS guidelines and Medicare Advantage requirements Nice to Have Skills & Experience Medicare Advantage Risk Adjustment experience Experience working with CMS-HCC models CRC (Certified Risk Adjustment Coder) certification Experience with EMRs and coding software platforms Background in a health plan, physician practice, hospital, or revenue cycle environment Audit and quality assurance experience Job Description Insight Global is seeking Medical Coders specializing in Risk...

Coder Job Summary The Coder's primary job function is to certify accurate billing for professional services and hospital procedures. This is accomplished through review of clinical encounters, confirming correct use of diagnosis and procedural codes and application of appropriate modifiers and CCI edits. The Coder provides education to providers to ensure proper completion of the medical record. Job Specific Competencies 1. Reviews clinical encounters presented via electronic lists to ensure proper submission of services prior to billing. a. Edits and corrects diagnosis and procedural codes and applies modifiers and CCI edits as required according to coding guidelines and department policy. b. Effectively utilizes coding software and/or books to confirm coding accuracy. c. Verifies referring provider, rendering provider, department and other critical data elements are accurate prior to submission of completed coding. 2. Receives and reviews paper fee slips for hospital services...

Medical CoderAt Sprinter Health, our mission is reimagining how people access care by bringing it directly into their homes. Nearly 30% of patients in the U.S. skip preventive or chronic care simply because they can't get to a doctor's office. For many, the ER becomes their first touchpoint with the healthcare system—driving over $300B in avoidable costs every year.By using the same technologies that power leading marketplace and last-mile platforms, we deliver care where people are, especially those who need it most. So far, we've supported more than 2 million patients across 22 states, completed over 130,000 in-home visits, and maintained a 92 NPS. Our team of clinicians, technologists, and operators have raised over $125M to date from investors like a16z, General Catalyst, GV, and Accel and enjoy multi-year runway.As a Medical Coder, you will be responsible for reviewing and abstracting professional medical records to ensure accurate code assignment. You'll play a critical role...

Job Description Job Description Overview Up to $500 in Bonuses! $250 Sign On Bonus and $250 Retention bonus after successful Probationary completion. ***Applies to external candidates only.   Certified Coders have the option to work virtually. Must reside in the state of WA, OR, ID, WI, FL, MT, GA, TX, AZ, AL, TN.   The Certified Medical Coder will be responsible for reviewing all medical record information to extract data and apply appropriate diagnoses and procedure codes for billing, internal and external reporting, research, and regulatory compliance. Accurately codes conditions and procedures as documented in the Official Guidelines for Coding and Reporting for Hospital Departments. Acts as a coding resource for team members as well as medical staff, ensuring coding practices fall with the established compliance guidelines for ICD-10CM/PCS, CPT & HCPCS according to American Medical Association (AMA) and CMS. Assigning codes utilizing an electronic...

Job Description Job Description Porter is hiring a Risk Adjustment Coder to join our Team!   Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience.    Position Overview We are seeking a certified coder with expertise in risk adjustment...

Risk Adjustment Coder Porter is hiring a Risk Adjustment Coder to join our team! Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter's Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member's specific needs, and directs Porter's team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience. Position Overview We are seeking a certified coder with expertise in risk adjustment coding and a specialization in...

Porter is hiring a Risk Adjustment Coder to join our Team! Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter's Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member's specific needs, and directs Porter's team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience. Position Overview We are seeking a certified coder with expertise in risk adjustment coding and a specialization in in-home health...

Professional Fee Coding Auditor / Claims Edit Specialist This position may be performed onsite or remotely; however, onsite work is preferred based on business needs. Preference will be given to qualified candidates who are able to work onsite and are located within a reasonable commuting distance. This position is open to candidates located within the continental United States. Due to state-specific employment requirements and workers' compensation regulations, we are unable to support remote work arrangements in the following locations: Washington, Ohio, Wyoming, North Dakota, Puerto Rico, and the U.S. Virgin Islands. At Northbay Health, the Professional Fee Coding Auditor / Claims Edit Specialist is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials. This role ensures coding accuracy, documentation integrity,...

Job Description Job Description Description The DRG Coder is responsible for reviewing inpatient medical records and accurately assigning diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS to determine the appropriate Diagnosis-Related Group (DRG) assignment.  This role ensures coding accuracy, reimbursement integrity, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent Practice Association (IPA) and Management Services Organization (MSO) environment, the DRG Coder partners with utilization management, care management, finance, and provider network teams to support accurate payment, risk adjustment, quality reporting, and medical expense analysis. What You'll Do Review inpatient hospital records and assign accurate diagnosis and procedure codes Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation Conduct coding validation and auditing to ensure compliance with...

Risk Adjustment Coder Specialist Main Office - Santa Barbara, CA 93110 Start Date 10/02/2026 Overview Salary Range $31.17 - $45.20 Hourly Position Type Full Time Category Financial Analytics Description Central Coast Salary Range: $31.17 - $45.20 Job Summary The Risk Adjustment Coder Specialist ensures accurate medical diagnosis data submission to CMS for CenCal Health Medicare Advantage D-SNP line of business. This role optimizes diagnosis documentation, identifies barriers to appropriate risk adjustment, oversees outsourced vendor coding for CMS compliance, and partners with provider outreach teams to educate providers on accurate and comprehensive medical coding. Duties & Responsibilities Perform reviews of records to identify, validate, and ensure accurate capture of diagnosis codes aligned with CMS-HCC, HHS-HCC, ICD-10-CM and applicable risk adjustment requirements. Oversee vendor coding activities, including monitoring work quality, reviewing vendor...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you’re stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical role in translating clinical documentation...