Cms hcc coder jobs | Healthcare Careers

Remote Risk Adjustment Coder | CMS HCC Specialist

CommonSpirit Health Bakersfield, CA

A healthcare organization is seeking a Coder to translate medical records into standardized codes and improve clinical documentation. This remote position requires an Associates degree and coding certifications. Key responsibilities include ensuring compliance with guidelines, educating providers, and safeguarding confidentiality of health information. Candidates should have expertise in CPT and ICD-10 coding and strong communication skills. A competitive pay range is offered alongside comprehensive benefits. #J-18808-Ljbffr

Full Time

Medical Coding and Billing Analyst

C2Q Health Solutions Hybrid (NY)

JOB PURPOSE: Responsible for supervising, evaluating, and consistently improving the day-to-day operations of Medical Practice. This role is responsible for accurate and timely billing of insurance claims and patient statements across multiple sites, implements accurate medical coding policies, and enhances operational processes. It involves acting as a liaison between coding operations and clinical staff, training and coaching medical personnel on coding guidelines, and ensuring the accuracy and timeliness of clinical documentation. Additionally, the role includes analyzing and optimizing diagnosis data submission processes, presenting performance results to leadership, and supporting HCC/RAF optimization strategies. The role will also oversee the training of Medical Practice Assistants, Physician and IDT disciplines in ICD-9/ICD-10 guidelines. JOB RESPONSIBILITIES: Responsible to deliver accurate and timely billing of insurance claims and patient statements for all...

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Medical Coding and Billing Compliance Auditor

CommuniCare Health Services Blue Ash, OH

Medical Coding and Billing Compliance Auditor Location: Remote Division: Coding Compliance About the Role: The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy, documentation integrity, ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have extensive knowledge of CPT coding, ICD-10-CM coding, E/M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access...

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Risk Adjustment Coder - Risk Management

Kettering Health Network Moraine, OH

KPN Pro Fee Coding Specialist This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] Demonstrate initiative for maintaining current knowledge of...

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Remote Certified Coder

Altegra Health Atlantic City, NJ

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient...

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Risk Adjustment Coder - Risk Management

Kettering Health Network Dayton, OH

KPN Pro Fee Coding Specialist This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] Demonstrate initiative for maintaining current knowledge of CPT,...

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Risk Adjustment Coder IHCI

Community Health Network Indianapolis, IN

Risk Adjustment Coder IHCI Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, "community" is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered and we couldn't do it without you. The Innovative Healthcare Collaborative of Indiana LLC (IHCI) is a company formed through the partnership of Community Health Network (CHNw) and Deaconess Health System (DHS). Both CHNw and DHS place high importance on continuing and advancing population health and value-based care to improve patient health outcomes. Reporting to the Clinical Documentation Integrity Manager,...

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Coding Auditor, Facility

Veracity OR

Coding Auditor, Facility Onsite Clackamas, OR To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Healthcare...

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Risk Adjustment Coder

Strive Health Denver, CO

Risk Adjustment Coder Denver, CO How You'll Make An Impact At Strive Health, patients come first. We're on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You'll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday. If you're looking for meaningful work where your contributions truly matter, you'll feel right at home at Strive! What You'll Do The Coder, Risk Adjustment Coding is responsible for supporting the Strive operational and clinical team and partner Nephrologists by reviewing risk adjustment visits for appropriate clinical documentation support. This role is responsible for supporting the growth and improvement of Strive's risk adjustment capabilities. The coder...

Certified Medical Coder

Apex Health Solutions Houston, TX

Certified Medical Coder Certified Medical Coder role is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with Risk Adjustment requirements. Key Responsibilities Follows CMS Risk Adjustment guidelines and has a complete understanding of their real-world application Reviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS standard requirements for valid submission Codes all diagnoses and services accurately and completely, from the medical record in accordance with the ICD-10-CM coding classification system Selects and accurately records all appropriate records and data on assigned chart abstraction projects Ability to meet productivity and accuracy requirements Performs other duties as assigned Qualifications High School Diploma or GED required A certification in one of the following is required:...

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Senior Risk Adjustment Coder

Power Personnel Sacramento, CA

Drive Accuracy. Influence Outcomes. Protect Revenue. We are seeking a highly experienced Senior Risk Adjustment Coder to play a critical role in risk adjustment accuracy, audit readiness, provider education, and clinical documentation excellence. Job Title: Senior Risk Adjustment Coder Location: Newark, CA (Candidates must currently reside within approximately 100 miles of the Newark area due to onsite operational needs.) Employment Type: Full-Time (Direct Hire) Salary Range: $91,000 – $119,000 annually, based on experience, skills, and internal equity About the Role: We are seeking a senior-level Risk Adjustment professional to support a leading healthcare organization focused on accurate HCC capture, audit readiness, documentation integrity, and provider engagement. This role is highly operational and collaborative in nature and is not a traditional production-only coding position. The ideal candidate will bring strong expertise across Risk...

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Certified Coder (Risk Adjustment Experience Required) - REMOTE

Molina Healthcare Long Beach, CA

Job Description Job Summary: Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties: Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. Builds positive relationships between providers and the business by providing coding assistance...

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Value Based Coder II

St Luke's Health Houston, TX

Job Summary and Responsibilities The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk‑adjusting conditions and supporting provider documentation improvement. Responsibilities Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding....

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Remote Certified Coder

Altegra Health Dallas, TX

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient...

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Risk Adjustment Coder IHCI

Community Health Network United States

Risk Adjustment Coder IHCI Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, "community" is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn't do it without you. The Innovative Healthcare Collaborative of Indiana LLC (IHCI) is a company formed through the partnership of Community Health Network (CHNw) and Deaconess Health System (DHS). Both CHNw and DHS place high importance on continuing and advancing population health and value-based care to improve patient health outcomes. Reporting to the Clinical Documentation Integrity...

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Hospital Based Outpatient Coder I - HIM - FT - Days - Remote Eligible

Memorial Healthcare System United States

Job Title Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Job Description Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing...

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Senior Medical Coder

RELI Group, Inc. United States

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD-9-CM/ICD-10-CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality assurance efforts....

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Sr Coding Compliance Auditor

CommonSpirit Health United States

Where You'll Work CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence. Job Summary and Responsibilities The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement, and revenue capture. Provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings, webinars, and...

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Hospital Based Outpatient Coder II - HIM - FT - Days - MSS - Remote Eligible

Memorial Regional Hospital Hollywood, FL

Job Opportunity At Memorial Healthcare System Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Job Summary Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance. Responsibilities For hospital encounters, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing. Reviews chargemaster generated CPT/HCPCS codes, when errors are found Coding Management is notified to alert Charge Management to educate department making errors. Makes appropriate coding...

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Coder 1-Risk Adjustment

Loma Linda University Medical Center Redlands, CA

Please Note: This is a hybrid position ; however, applicants must reside in California and live within a 2-hour radius of Redlands, CA to be considered. Department: UHC: Managed Care Job Summary: The Coder 1 * Risk Adjustment is responsible for concurrent, prospective, and retrospective clinical documentation review as it pertains to Risk Adjustment Data Validation (RADV) timelines, with an emphasis on completeness and accuracy of provider documentation related to severity of illness and supporting clinical care plan(s) for the validation of Hierarchical Condition Category (HCC) diagnoses. Initiates communication, verbal and written, with providers to facilitate clarification of need for greater specificity, clinical support, and/or completeness of the progress notes. Provides compliant education related to documentation integrity, completeness, and consistency. Keeps providers up to date on CMS, ICD-10-CM, AHA Coding, health plan etc. guidelines as it pertains to Risk...

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Coder I - Billing & Audit - FT - Days - MSS - Hybrid Eligible

Memorial Regional Hospital Hollywood, FL

Job Title Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Job Description Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category),...

UH

CODER (CERT) - Full Time

Universal Health Services Riverside, CA

Riverside Medical Clinic Come and join the RMC Family! We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Quality healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care. Medical Coding Specialist SUMMARY: Responsible for abstracting, reviewing, auditing and the education of all coding and compliance processes, as they relate to CPT, HCPCS and ICD 10 and/or HCC activity. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION...

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Facility Coder - Certified

Confluence Health Wenatchee, WA

Salary: $26.62 - $41.66 Overview Located in the heart of Washington, we enjoy open skies, snow-capped mountains, and the lakes and rivers of the high desert. We are the proud home of orchards, farms, and small communities. Confluence Health actively supports the communities we serve and their quality of life through our community support program and through our individual efforts as involved community members. Benefits Medical, Dental & Vision Insurance Flexible Spending Accounts & Health Saving Accounts Paid Time Off Generous Retirement Plans Life Insurance Long-Term Disability Gym Membership Discount Tuition Reimbursement Employee Assistance Program Adoption Assistance Shift Differential For more information on our Benefits & Perks, click here! Summary Up to $500 in Bonuses! $250 Sign On Bonus and $250 Retention bonus after successful Probationary completion. ***Applies to external candidates only. This position has the option to work virtually. Must...

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Physician Medical Coder- Remote

ProEd Consulting and Staffing Delano, CA

Job Summary - Physician Medical Coder, Family Practice - Assign accurate ICD-10-CM diagnosis and CPT procedure codes for family practice encounters - Code and validate Evaluation & Management (E/M) services per current CMS guidelines - Support coding and documentation for Annual Wellness Visits (AWV), Chronic Care Management (CCM), and Transitional Care Management (TCM) - Perform Hierarchical Condition Category (HCC) risk-adjustment coding and documentation review - Assist with Merit-based Incentive Payment System (MIPS) quality reporting and compliance - Review provider documentation for completeness and compliance; follow up with providers as needed - Ensure compliance with HIPAA, CMS, OIG, and other federal and state regulations - Support Revenue Cycle Management (RCM) by ensuring clean claims, reducing denials, and assisting with appeals - Stay current with coding updates, payer policies, and regulatory changes - Maintain productivity and accuracy standards set...

395 cms hcc coder jobs found