258 coder 1 risk adjustment jobs found

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Risk Adjustment Coder, to join in leading the organization forward. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. Learn more about McLaren Health Plan at...

Risk Adjustment Coder McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Risk Adjustment Coder, to join in leading the organization forward. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. Position Overview: The...

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...

Job Description Position Purpose: This position is responsible for ongoing risk adjustment improvement activities. Under general supervision, this position includes ongoing quality improvement activities to ensure the organizations Risk Adjustment programs are implemented and meet all government requirements. Nature and Scope: This role does not manage people.

Risk Adjustment Coding Auditor, Sr page is loaded## Risk Adjustment Coding Auditor, Srremote type: Remotelocations: Remote Oregon: Remote Utah: Remote Texas: Remote Idaho: Remote Wisconsintime type: Full timeposted on: Posted 2 Days Agojob requisition id: JR100739Risk Adjustment Coding Auditor, Sr---------------------------------------------------------------The Coding Auditor, Senior performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. Specific approaches to job duties vary depending on the department.**Estimated Hiring Range:**$81,000.00 - $99,000.00**Bonus Target:**Bonus - SIP Target, 5% AnnualCurrent...

Physicians' Primary Care of Southwest Florida is a premier physician-owned and managed multi-specialty practice with locations in Cape Coral, Estero, Fort Myers, and Lehigh Acres. We are currently seeking an in-house HCC Risk Adjustment Coder for our Compliance and Coding department located in Fort Myers. This is not a remote coding position, must reside in Lee County Florida . Schedule is Monday through Friday, Day Shift. Sample of Responsibilities: Perform prospective reviews and clinical documentation improvement opportunities Assist healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation The individual will conduct chart reviews to abstract data not submitted by providers Initiate opportunities to improve documentation Assists other team members as needed to meet the goals of the department. Maintain strictest confidentiality and adhere to all HIPAA guidelines and regulations. Position...

Coder II - ProFee Trauma Surgery Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments. Includes inpatient E/M coding and clinic E/M coding as well as trauma surgery coding and bedside procedure coding. Experience required in at least E/M coding or trauma surgery coding. Facility Specific: Responsible for coding SDS, Observation, and as needed ED, Diagnostic, and Ancillary records. Professional Fee Specific: Responsible for coding Surgical Records, Evaluation & Management Encounters, ED (with E&M) and as needed Diagnostic,...

Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Interprets a wide variety of clinical and diagnostic documentation to determine the opportunity for Hierarchical Condition Category (HCC) diagnosis selection and/or removal in accordance with official coding guidelines. Assigns appropriate ICD-CM (current edition) codes to outpatient office-based claims, tracks capture results, and reports clinical documentation patterns and trends. Supports all risk adjustment projects by complying...

Become a part of our caring community and help us put health first The Medical Coder extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Medical Coder confirms appropriate diagnosis related group (DRG) assignments. Review and analyze patient medical records to identify accurate ICD-10-CM diagnosis codes, ensuring all relevant conditions affecting patient's care are documented to the highest level of specificity. Validate that documentation supports risk adjustment coding and HCC capture in compliance with regulatory guidelines. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Decisions are regarding the daily...

Job Summary This position requires onsite work as needed. The Health Information Coder I is an entry-level coder with a basic knowledge and skill set to utilize ICD-10-CM, CPT and HCPCS classifications 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 employee will work eight (8) hours per day, excluding meal periods, on five (5) consecutive days within a workweek. The workweek schedule is set between the employee and the manager and may be scheduled to start any day of the week based on manager approval. The final salary and offer components are subject...

Title: Coding Auditor, Facility Work Type: Full-Time Location: Clackamas, OR R emote Job After Completing Satisfactory Training At The Job Site MUST-HAVES : Basic Qualifications: Experience Minimum two (2) years experience in a directly related coding field Education A High School Diploma or General Education Development (GED) is required. License, Certification, Registration The candidate must have 1 from the following list: Registered Health Information Technician Certificate Certified Coding Specialist Registered Health Information Administrator Certificate Additional Requirements: Previous experience with EMR patient documentation systems with intermediate knowledge and skill in the use of a computer. Advanced knowledge of disease processes, diagnostic and surgical procedures, ICD-10-CM, ICD-10-PCS, HCPCS/CPT classification systems, and health information/medical record department responsibilities with knowledge of government regulations and areas of scrutiny...

Title - Inpatient Facility Medical Coder (40h Day) Location - Clackamas, OR, US Job Type - Permanent | Remote Required: Minimum five (5) years experience in coding with four (4) years inpatient facility coding The candidate must have 1 from the following list: Registered Health Information Technician Certificate Certified Coding Specialist Registered Health Information Administrator Certificate Advanced knowledge of medical terminology, pharmacology and medial coding principles for ICD-10-CM, ICD-10-PCS, HCPCS/CPT and coding. Advance knowledge of disease processes, diagnostic and surgical procedures, ICD-10-CM, ICD-10-PCS, HCPCS/CPT classification systems, health information/medical record department responsibilities with knowledge of government regulations and areas of scrutiny for potential fraud and abuse issues. Job description Candidates must reside either in Washintgon or Oregon to be considered for this position. To independently and efficiently...

Senior Risk Adjustment Coder The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. Locations: Stanford Health Care - University Healthcare Alliance What You Will Do Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses. Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes. Inquire with clinicians the recommended HCC diagnosis for chart addendum. Collaborating with...

Certified Professional Coder (Cpc) Lead/Provider Liaison A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. This is a contract position with my direct client. Job Description Direct client need- immediate interviews- we have a strong hold, with many consultants working onsite! Location could be: Newark, NJ OR West Trenton OR Ewing OR Wall, NJ. Duration: contract to hire. Job summary: The provider liaison is accountable for extracting insights specific to providers and provider groups regarding commercial risk adjustment and developing...

Overview Reviews and audits claims for billing, coding, services and other compliance or reimbursement issues. Assists with non-clinical aspects of the claims review process and acts as a coding resource. Provides training and support to Medical Care at Home Clinicians and staff to provide best practices of claims coding. Applies coding skills to various initiatives to ensure compliance in claims submissions. Works under moderate supervision. What We Provide Per Diem team members are eligible for some benefits and can access our extensive Employee Assistance Program that includes financial, legal, and mental health counseling programs as well as participate in a 403b retirement savings program. What You Will Do Reviews medical claims, records and other requested information for billing, coding and other compliance or reimbursement related issues; makes coding and documentation recommendations for adherence to risk adjustment models. Reviews medical...

Risk Adjustment Coder Specialist Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required...

We are looking for experienced 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 of diagnosis and...

Our Promise To You Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Job Description Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding...

Medical Coder Multi-Specialty (Hospital & Clinic) Location: Kingwood-Hybrid 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 & Documentation Review Accurately assign ICD-10-CM, CPT, and HCPCS Level...

Value Based Coder II 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. 1. 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. 2. Advanced Documentation...

Risk Adjustment Coder Specialist Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for...

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 a 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...

Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose‑minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403‑B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well‑being Resources Mental Health Resources and Support Pet Benefits Schedule: Full time Shift: Day (United States of America) Address: 3100 E FLETCHER AVE City: TAMPA State: Florida Postal Code:...