30 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

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...

Riverside Medical Clinic Coding Specialist 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 and/or Experience: One year minimum experience in the HCC coding field and/or CPT, HCPCS and ICD 10 experience. Proficient in excel and computer friendly. Certificates, Licenses, and Registrations: Current Medical Coding certificate specific to CRC, CPC or CCS required. Essential Functions: Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and...

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...

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...

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...

Responsibilities 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. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. 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. 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,...

Elevate your career as a Senior Risk Adjustment Coder and make a meaningful impact on Medicare Advantage programs! Join a dynamic team where your expertise in HCC coding, chart review, and provider collaboration directly influences revenue integrity and audit readiness. If you excel in compliance, audit validation, and clear communication, this opportunity is designed for you. About the Job Competitive Pay: $140,000–$170,000 annually Shift Days: Regular Business Hours Shift Time: Standard Business Hours Start Date: ASAP Department: Risk Adjustment Location: California (Bay Area preferred; remote work possible for qualified CA candidates) Duration: Full-time, permanent Benefits Competitive salary and benefits package Opportunity to impact revenue and compliance Collaborative, team-focused environment Work with leading health plans and systems Flexible work arrangements for California-based candidates Continuous professional development Required Qualifications CPC and CRC...

Health Coder - Hcc & Risk Adjustment Burlingame, CA 94010 Overview Salary Range $42.79 - $48.75 Hourly Description The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization's quality outcomes and financial performance. Essential Job Functions: Hcc Coding and Risk Adjustment (Ra) Program Support Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with Hcc and risk adjustment guidelines....

Senior Risk Adjustment Coder 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...

Audit PCP, specialist and hospital records for additional HCC diagnoses. Audit all assigned providers wellness visits and send a CAP based on last year chronic conditions. Log the patients Prepare provider report card following completion of each PCP review utilizing comments function of qHMO. Forward provider report card to HCC Manager. Update encounter information with additional HCC data. Conduct Risk Adjustment Data Validation (RADV) audits as requested by HCC Manager. Orient providers in the use of qHMO and documentation for Risk Adjustment. Reinforce to providers the necessity for thorough and accurate documentation and reporting of Risk Adjusted diagnoses. Contact a provider when necessary to clarify medical record documentation. Attend required meetings and participate in committees as requested by management or administration of HVVMG. Enhance professional growth and development through in-service, educational programs and conferences. Maintain a...

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. Our clients include the...

Job Description 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...

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 chronic or...

Details Client Name WelbeHealth - Modesto Job Type Local Offering Non-Clinical Profession Professional Specialty IT Job ID 13826730 Job Title Coding Auditor Weekly Pay $1040.0 Shift Details Shift Days 5x8 Scheduled Hours 40 Job Order Details Start Date 11/27/2023 End Date 02/26/2024 Duration 13 Week(s) Job Description Duties and Responsibilities: -Assist with retrospective and concurrent coding for PACE (Programs of All-Inclusive Care for the Elderly) Dual participants. -Conducts pre-visit chart preparations and post visit chart reviews. -Conducts audits and participates in provider education programs to ensure compliance with CMS risk adjustment diagnosis coding guideline. -Works closely with direct manager in identifying opportunities for HCC coding education. -Complete all required documentation in a timely and accurate manner. -Protect privacy and maintain confidentiality of all company procedures and...

Job Opportunity Job Information Job Opening ID 9337 Date Opened 10/12/2023 Job Type Contract Language Skills English Location Orange, CA Industry Health Care City Orange State/Province California Country United States Zip/Postal Code 92856 Job Description Responsibilities Reports to: Manager, Coding The radiation oncology coder will be responsible to abstract orders, charges and related diagnoses from radiation oncology records to ensure services billed are consistent with the record documentation The coder will ensure compliance with all the clinical billing and coding regulations and will work with the faculty and staff to ensure accurate documentation of billable services The coder will determine and input appropriate ICD-10 CM and other codes for all radiation therapy procedures and analyze and validate that all charges are interfaced with the appropriate ICD10 and CPT codes The coder will be become efficient with the record and verify system ARIA where they...

Lead Outpatient Medical Coder The Lead Outpatient (OP) Medical Coder assists the HIM OP Coding Manager with administrative functions specific to all outpatient coding operations. Duties may be varied and may include many of the following: assisting the OP Coding Manager to organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of production-coder performance, develop and implement quality improvement activities, train and mentor staff, provide feedback coding error findings and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. The Lead OP Medical Coder is responsible for serving as a subject matter expert in coding processes, providing advanced technical guidance, and ensuring coding accuracy, compliance, and productivity standards are met. The position supports coders and auditors through consultation, mentoring, and...

Job Title Coder (Hospital Billing) Job Description The Coder (Hospital Billing) reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM and ICD-10-PCS codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines. Responsibilities Verifies that all ICD-10-CM and ICD-10-PCS codes are correctly captured. Verifies that physician and other key information is correctly abstracted. Resolves billing related errors and assists with workflow changes and process improvement projects. Meets ongoing productivity and quality accuracy rate of 95% or better. Coder III assigns codes for diagnoses, treatment, and procedures for inpatient surgeries. Determines the correct principal...

Remote ICD-10 Outpatient Coder, AAPC Certified, Short-Term AI Pilot Project Job Type: Contract, 1099, Remote, Part-Time Pay: $40 to $45 per hour, depending on experience Location: Remote, US-based only About the Project: Nightingale's List is sourcing AAPC-certified outpatient coders for a short-term pilot project with a healthcare AI company. This is a contract opportunity to support an exciting initiative comparing US coder performance against established benchmarks, with strong potential to grow into a larger ongoing engagement based on pilot results. What You'll Be Doing: Reviewing clinical transcripts and assigning accurate ICD-10-CM codes Identifying primary diagnoses and secondary conditions Highlighting sentence-level text spans that support each coding decision Completing 5 test cases followed by approximately 20 production cases Working within the client's coding platform, full training and gold standard examples provided Estimated 30 to 45 minutes per case,...

Salary : $105,597.80 - $145,114.92 Annually Location : Riverside Job Type: Regular Job Number: 26-74191-01 AL Department: RUHS-Medical Center Opening Date: 03/03/2026 Closing Date: Continuous For questions regarding this position, please contact the Recruiter listed in the Supplemental Information section. ABOUT THE POSITION Riverside University Health System (RUHS)is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department. Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to...

Coding Compliance Auditor Riverside University Health System (RUHS) is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department. Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to ensure timely and accurate responses to inquiries. Additionally, the role supports ongoing program development through training initiatives and process improvements, delivers coding presentations to diverse audiences including physicians and other staff. The ideal candidate will have at least five years of progressive...

Hcc Risk Adjustment Auditor/Coder We are looking for HCC Risk Adjustment Auditors/Coders to join our team! Position Summary: The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding documentation and data in the medical record and HCC database. The HCC Risk Adjustment/Auditor reports on the accuracy and consistency of the data in accordance with accepted and established standards. Risk Adjustment Auditors collaborate with the Manager to provide expertise in the use and application of coding classifications, such as ICD-9-CM and/or ICD-10-CM. Auditors also record documentation to ensure compliance in the collection of outpatient diagnoses and services. Essential Duties and Responsibilities include the following: Works as an integral member of the Finance Department. Code review super bills and patient medical records for proper use...

We are looking for experienced Sr. HCC Risk Adjustment Auditors/Coders to join our team! Position Summary The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding documentation and data in the medical record and HCC database. The HCC Risk Adjustment/Auditor reports on the accuracy and consistency of the data in accordance with accepted and established standards. Risk Adjustment Auditors collaborate with the Manager to provide expertise in the use and application of coding classifications, such as ICD-9-CM and/or ICD-10-CM. Auditors also record documentation to ensure compliance in the collection of outpatient diagnoses and services. Essential Duties and Responsibilities Works as an integral member of the Finance Department. Code review super bills and patient medical records for proper use of diagnosis and procedure codes. Interface...

Job Title Radiation Oncology Coder Job Description Responsibilities Reports to: Manager, Coding The radiation oncology coder will be responsible to abstract orders, charges and related diagnoses from radiation oncology records to ensure services billed are consistent with the record documentation The coder will ensure compliance with all the clinical billing and coding regulations and will work with the faculty and staff to ensure accurate documentation of billable services The coder will determine and input appropriate ICD-10 CM and other codes for all radiation therapy procedures and analyze and validate that all charges are interfaced with the appropriate ICD10 and CPT codes The coder will be become efficient with the record and verify system ARIA where they will review the department daily charges for accuracy prior to interface from ARIA to EPIC Is always compassionate and empathetic for both patients and team members; makes eye contact, smiles and or...