273 cms hcc coder jobs found

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

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...

Coder I - Billing & Audit - FT - Days - MSS - Hybrid Eligible 2 days ago Be among the first 25 applicants 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. Summary 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...

Job Title: Provider Coding Educator / Auditor Department: Revenue Integrity & Compliance Employer: Southeast Primary Care Partners / Southeast Medical Group, P.C. FLSA Status: Non-Exempt (Hourly) Position Summary The Provider Coding Educator/Auditor is responsible for driving accurate clinical documentation, compliant coding, and revenue integrity across Southeast Primary Care Partners’ ambulatory practices. The role combines prospective and retrospective E/M, procedural and risk‑adjustment auditing with in‑person and virtual provider education. Up to 50 % regional travel is required to meet with physicians on flexible schedules, including early‑morning huddles and occasional after‑hours sessions. This is an hourly, non‑exempt position governed by the Fair Labor Standards Act (FLSA) overtime provisions and subject to Occupational Safety and Health Administration (OSHA) workplace safety standards. Requirements Essential Functions Perform focused and random audits of...

Job Summary and Responsibilities As a Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients' medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. 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. Ensure that the diagnosis codes for...

EMR Coding Auditor Summary/Objective: The EMR Coding Auditor (ECA) facilitates improvement in the overall quality, completeness and accuracy of medical record documentation. The individual will perform medical record reviews based on CMS Quality Standards and validating active chronic problems for each patient and communicating with the physician to ensure Hierarchical Condition Coding is met, as well as accurate and up-to- date patient problem lists are documented in the EMR. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support resource utilization and patient outcomes. The ECA reports to the Population Health Manager. It is the obligation of each Galen associate to comply with and promote the Galen mission, core values, privacy and corporate/departmental/site policies (I.E. Dress code, Time and attendance, et al). Essential Functions: Coordinate...

Join to apply for the Health Information Management Inpatient Coding Auditor Sr. FT, Days, - Remote role at Prisma Health . Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work queue management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. Reviews and responds to inpatient denials as needed. Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. Essential Functions All team members are expected to be...

Hybrid | Des Moines, IA (Onsite Tues–Thurs, Remote Mon/Fri) $40/hour | 6-Month Contract with Potential for Conversion We are seeking a Certified Risk Adjustment Coder (CRC) to support Medicare Risk Adjustment initiatives through detailed HCC medical record reviews and direct provider engagement. This role is ideal for someone confident, collaborative, and comfortable working onsite with provider teams to drive documentation accuracy and performance improvement. This position requires onsite presence Tuesday–Thursday in Des Moines, IA with 10% local travel , and remote flexibility on Mondays and Fridays. Position Overview This role performs concurrent medical record reviews to ensure accurate capture of HCC conditions and appropriate documentation reflecting patient severity of illness. The coder will collaborate closely with physicians, clinical leadership, and provider engagement teams to improve documentation practices and support compliance with CMS guidelines. Key...

Job Description Employment Duration: 3 months Location: Fully Remote Openings: 2 The Health Information Coder I is an entry‑level coder with basic knowledge and skill set to utilize ICD‑10‑CM, CPT, and HCPCS classification systems to code across various healthcare settings, including outpatient, emergency department, and ancillary services. This role ensures coding accuracy, compliance with regulatory guidelines, and adherence to UCSF policies, supporting proper reimbursement and revenue cycle integrity. The Coder I collaborates with healthcare providers, revenue cycle teams, and compliance departments to resolve documentation issues and maintain high standards of coding performance. The position is hybrid and may require travel to UCSF Health for business purposes. The incumbent must provide a safe and private home office environment for conducting UCSF business. Key Responsibilities Assign accurate ICD‑10‑CM, CPT, and HCPCS codes for diagnoses, procedures, and services based...

4 days ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. Colorado Community Managed Care Network provided pay range This range is provided by Colorado Community Managed Care Network. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $53,000.00/yr - $70,000.00/yr Direct message the job poster from Colorado Community Managed Care Network Director of Human Resources and Business Operations Description https://recruiting.paylocity.com/recruiting/jobs/All/3736f22c-4667-493c-828e-5131b681ff09/Colorado-Community-Managed-Care-Network. Applicants will must apply through this link to be considered. Responsibilities: The Value Based Coding Advisor will interact with operational and clinical leadership to assist in the identification of Risk Adjustment/HCC coding opportunities, and will provide targeted education to CHC providers, billers, coders, and support staff to support...

Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual, family, and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5‑Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Position Summary Performs chart retrieval, medical record review, HCC identification and data quality oversight for risk mitigation and revenue recovery for both Medicare and ACA services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for coding questions/issues. Determines...

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service,...

Description Coder - PACE/ElderPlace Candidate must reside in either CA, OR or WA. Schedule: Remote position working Mon-Fri Day shift Job Description: The HCC Coder Analyst is responsible for detailed diagnostic coding associated with Risk Adjustment and HCC coding. This impacts revenue and CMS compliance with the coordination of technically detailed coding applications that impacts operations, programmatic and information systems, as well as contracted providers. The Coder Analyst will have a comprehensive understanding of ICD-9, ICD-10 and other types of coding for PACE programs (both Portland & Seattle), contracted facilities, and providers. Providence PACE is a Program of All-Inclusive Care for the Elderly that strives to keep older adults as healthy as possible living in the community through clinics, home visits and more. Join our team to help empower elders in your community to live active, independent lives. Required Qualifications:...

Job Description Job Description South Los Angeles based FQHC looking for onsite Certified HCC coder . *This is not a remote position Conduct the necessary audits of medical record to verify the physicians have appropriately documented the diagnoses then code these diagnoses in ICD-10 for Medicare Risk Adjustments/Medicare Advantage. Evaluate medical information (Outpatient/Inpatient) documentation from a clinical standpoint for evidence of the possibility of additional medical conditions that may not have been documented in the past, and ensure accurate coding of the encounter data and recommend processes for accurate coding practices. This process involves a very strong understanding of medical coding. Ascertain that medical record documentations have accurate diagnoses and conditions to assure not to up-code, fraudulently or misrepresent the patient condition and ensure compliance to prepare for random CMS medical records audit HEDIS coding and record collection...

Sr. Associate, Health Care Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute....

Coder - PACE/ElderPlace Candidate must reside in either CA, OR or WA. Schedule: Remote position working Mon-Fri Day shift Job Description: The HCC Coder Analyst is responsible for detailed diagnostic coding associated with Risk Adjustment and HCC coding. This impacts revenue and CMS compliance with the coordination of technically detailed coding applications that impacts operations, programmatic and information systems, as well as contracted providers. The Coder Analyst will have a comprehensive understanding of ICD-9, ICD-10 and other types of coding for PACE programs (both Portland & Seattle), contracted facilities, and providers. Providence PACE is a Program of All-Inclusive Care for the Elderly that strives to keep older adults as healthy as possible living in the community through clinics, home visits and more. Join our team to help empower elders in your community to live active, independent lives. Required Qualifications: Associate's Degree in Business or...

Job Description Job Description Remote Medical Coder Location: remote, Florida Compensation: $21-26/hr., commensurate with experience and qualifications Our Story : Physician Care Centers (PCC) is a growing healthcare MSO with 70+ value-based primary care clinics serving patients across Florida, Texas, Georgia, South Carolina, and Nevada. With a team of 500+ professionals, we’re committed to delivering exceptional care and improving patient outcomes. The Role: We’re seeking a Medical Coder to ensure accurate, compliant coding that supports revenue integrity and risk adjustment performance. Under the supervision of the Revenue Cycle Manager, you’ll review provider encounters, ensure accurate HCC capture, collaborate with clinical teams, and support documentation improvement. What You’ll Do: Review and accurately code all provider encounters (office visits, procedures, preventive care, chronic condition management). Ensure complete and compliant...

Job Summary and Responsibilities As a Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients' medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. 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. Ensure that the diagnosis codes for each...

https://www.livebinders.com/b/3569203?tabid=8cd9721d-3f97-b2c4-26cf-05ac9cb419ca What You Should Know About the Certified Coder- Clinic : Monday- Friday: Typical hours 8:00- 4:30. No weekends or call. This position is based within Jefferson Regional Practice Management Clinics . Please refer to job posting on which practice management clinic this position is referring to. Job Summary: A Certified Coder within Practice Network is responsible for assigning medical codes to patient records to ensure proper healthcare billing and reimbursement by using coding systems such as ICD-10-CM and CPT to accurately assign codes. Certified Coder-Clinic Qualifications: High School diploma or equivalent required. Completion of a credentialed Coding education program required. Technical Diploma: Medical Coding Certification from AAPC or AHIMA required. Associate or Bachelor's Degree in Health Information Management, Medical Coding, or other related field...

Job Description Job Description Medical Coder – Multi-Specialty (Hospital & Clinic) Location: Kingwood or Remote Employment Type: Full-Time Reports To: Revenue Cycle Manager Position Summary We are seeking a highly skilled, detail-driven, and high-producing Certified Medical Coder with multi-specialty experience to join our growing healthcare organization. This role requires strong proficiency in both hospital and outpatient clinic coding, with specialty expertise in: • Cardiology • Urology • Dermatology • General Surgery • Pulmonology The ideal candidate has 2+ years of coding experience, maintains current certification (AAPC or equivalent), and consistently demonstrates accuracy, productivity, and strong clinical understanding across multiple service lines. This is a high-impact role within a performance-driven, collaborative organization focused on compliance, precision, and revenue integrity. Core Responsibilities Coding &...

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: Certified...

HIGHLY PREFERRED MINIMUM 2 years of adjustment coding** Primary Care Adjustment Coding Experience HIGHLY PREFERRED** Traveling required to assigned centers** Florida Medical Clinic Orlando Health Job Title Medical Risk Adjustment Coder Schedule Hours Monday - Friday 800am-500pm Department Utilization Management Location 2100 Via Bella Blvd Land O Lakes HIGHLY PREFERRED MINIMUM 2 years of adjustment coding** Primary Care Adjustment Coding Experience HIGHLY PREFERRED** Traveling required to assigned centers** Position Summary The Medical Risk Adjustment Coder supports the physician practices and the Care Coordination Department with Coding Improvement activities using various clinical data systems Why is Florida Medical Clinic Orlando Health your best place to work? ✅ Education & Career Growth - Tuition reimbursement, Public Service Loan Forgiveness (PSLF), and leadership development programs. ✅ Health & Wellness - Comprehensive medical, dental, vision,...

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...

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service,...