10 clinical risk adjustment coder jobs found

Risk Adjustment Coder Location: Virginia Beach, VA Work Shift: First (Days) Overview: Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA! Hours: Monday - Friday, 8:00AM -5:00PM, dayshift. This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week. The role also includes travel as needed to support business objectives and team collaboration. Responsibilities: 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 CMS/HHS...

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. #J-18808-Ljbffr

Clinical Coding Coordinator (Lead Coder) - Hospital Outpatient The Clinical Coding Coordinator (Lead Coder) provides advanced coding expertise to ensure the accuracy, integrity, and completeness of coded data across hospital services. The coordinator performs pre-bill and retrospective validation reviews, resolves complex coding issues, and serves as a resource to coding, CDI, and related teams to ensure adherence to official coding guidelines and documentation standards. This role focuses on complex case review, quality oversight, and ensuring the integrity of coded data submitted for reimbursement, quality reporting, and value-based payment models. Performs pre-bill and retrospective reviews to validate the accuracy of diagnosis and procedure coding, sequencing, and DRG or APC assignment. Identifies and resolves coding issues that delay account completion and ensures documentation supports accurate capture of severity of illness and risk of mortality. Reviews and validates coding...

Position Objective The Inpatient Medical Coder under the supervision of the Manager of Coding and Data Quality accurately codes hospital inpatient accounts for the purpose of appropriate reimbursement, research, statistics and compliance to federal and state regulations in accordance with established ICD-10-CM/PCS coding classification systems. Essential Job Duties Analyzes inpatient cases, identifies and assigns ICD-10 diagnostic and PCS procedural codes for the purpose of reimbursement, research and compliance with federal and state regulations. Demonstrates comprehensive knowledge of coding nomenclature to ensure accurate MS-DRG MCC/CC and APR-DRG/SOI/ROM and POA assignments. # Utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed. Sends coding queries to providers and communicates with CDIS’ when provider queries are clinical in nature. # Monitors assigned...

Position Objective The Inpatient Medical Coder under the supervision of the Manager of Coding and Data Quality accurately codes hospital inpatient accounts for the purpose of appropriate reimbursement, research, statistics and compliance to federal and state regulations in accordance with established ICD-10-CM/PCS coding classification systems. Essential Job Duties Analyzes inpatient cases, identifies and assigns ICD-10 diagnostic and PCS procedural codes for the purpose of reimbursement, research and compliance with federal and state regulations. Demonstrates comprehensive knowledge of coding nomenclature to ensure accurate MS-DRG MCC/CC and APR-DRG/SOI/ROM and POA assignments. # Utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed. Sends coding queries to providers and communicates with CDIS’ when provider queries are clinical in nature. # Monitors assigned...

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...

Risk Adjustment CoderSentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA!Hours: Monday - Friday, 8:00AM -5:00PM, dayshift.This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week. The role also includes travel as needed to support business objectives and team collaboration.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 CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical...

## Risk Adjustment CoderApplyremote type: Hybridlocations: SMG Administrationtime type: Full timeposted on: Posted Todayjob requisition id: JR-103351**City/State**Virginia Beach, VA**Work Shift**First (Days)**Overview:**# **Overview**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 CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training,...

Amazon One Medical Senior Health Revenue Cycle As a member of the Amazon One Medical Senior Health Revenue Cycle team, the Medical Coder I will be responsible for supporting Clinical and Revenue Cycle teams in reviewing the coding accuracy of claims. This role reports into the Manager I, Finance. As part of Amazon Health Services, you will find yourself working with exceptionally talented and dedicated people committed to driving financial improvement, scalability, and process excellence. To support our growth, this candidate must possess a strong passion for accountability, setting high standards, raising the bar, and driving results through constant focus on improving existing and future state operations, systems, and processes in collaboration with management. Key job responsibilities: Managing multiple coding related projects and ensuring deliverables are up to One Medical standards while being turned around in an acceptable time frame Remaining current on CPT,...

Job Title 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 CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training, monitoring, & auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. Performs vendor quality oversight audits; reviews and/or makes final coding determination for...