Coder auditor risk adjustment jobs

Hybrid HCC QA Coder/Auditor — Risk Adjustment Expert

Blue Cross Blue Shield of Arizona Phoenix, AZ

A health insurance provider seeks a Quality Assurance Coder/Auditor based in Arizona to develop risk mitigation and education programs. Responsibilities include reviewing medical records, coding for accuracy, and educating providers on best practices. The position requires at least 5 years of coding experience, with proficiency in HCC coding, and certifications like CCS-P or CPC. This hybrid role promotes flexibility, allowing candidates to work both onsite and remotely within Arizona. #J-18808-Ljbffr

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HCC Auditor & Coder — Risk-Adjustment Specialist (LA)

TEKsystems Los Angeles, CA

TEKsystems is seeking an HCC Auditor/Coder in Los Angeles, CA, to improve the accuracy of provider documentation. The role involves auditing medical records, coding reviews, and collaborating with providers for best practices. Applicants need a high school diploma, coding certification, and some familiarity with CPT, ICD, and HCPCS coding methodologies. The position offers a pay range of $25-$35/hr and includes benefits like medical coverage and a 401(k) plan. This is an onsite, contract position. #J-18808-Ljbffr

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Hybrid QA Coder/Auditor - HCC & Risk Adjustment

Blue Cross Blue Shield of Arizona Phoenix, AZ

A regional health insurance provider in Phoenix seeks a Quality Assurance Coder/Auditor to develop risk mitigation programs and educate providers. The candidate should have 5 years of coding experience with expertise in Hierarchical Condition Categories (HCC). Responsibilities include medical record reviews, coding analysis, and providing education to healthcare professionals. The position requires residency in Arizona and offers a hybrid work environment, enhancing work-life balance. #J-18808-Ljbffr

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Senior HCC Risk Adjustment Auditor & Coder - West Hills

Regal Medical Group Los Angeles, CA

Regal Medical Group is seeking experienced Sr. HCC Risk Adjustment Auditors/Coders to enhance coding practices and uphold auditing standards. The role involves maintaining quality assurance, conducting code reviews, and collaborating with healthcare staff to optimize documentation accuracy. Candidates should possess technical expertise in ICD-9-CM or ICD-10-CM, be certified (AAPC/AHIMA), and demonstrate strong communication skills. Benefits include comprehensive medical coverage, retirement plans, flexible spending accounts, and other perks like paid time off and tuition reimbursement. #J-18808-Ljbffr

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Senior Risk Adjustment Coder & CDI Auditor

Stanford Health Care - ValleyCare Stanford, CA

A healthcare organization is seeking a Senior Risk Adjustment Coder to perform code audits and compliance tasks. The ideal candidate should have over 5 years of experience and a solid understanding of coding guidelines. This role requires effective communication and problem-solving abilities to ensure accurate HCC coding while collaborating across departments. Competitive hourly salary range of $44.13 - $57.36 is offered. #J-18808-Ljbffr

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QA Coder/Auditor (Hybrid) — Risk-Adjustment Expert

Blue Cross Blue Shield of Arizona Phoenix, AZ

A leading health insurance provider in Arizona seeks a Quality Assurance Coder/Auditor to develop risk management and provider education programs. This hybrid role requires 5 years of professional coding experience, with 3 years focused on HCC coding. The ideal candidate will ensure coding accuracy in medical records and provide training to healthcare providers. Applicants must have a high school diploma and relevant certifications, with a preference for those with Medicare Advantage experience. #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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Sr Coding Compliance Auditor

Common Spirit Health Chattanooga, TN

Sr Coding Compliance Auditor Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings. 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 online modules. Develops, maintains and presents coding and compliance educational materials to staff and clinicians. Collaborates with the coding team to support the needs of the organization. The...

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Coding Compliance Auditor (2223)

US Heart and Vascular Franklin, TN

Coding Compliance Auditor Fully Remote Overview Position Type Full Time Education Level High School Diploma/GED Category Other Positions Description US Heart and Vascular is in need of a Remote Coding Compliance Auditor to join our team. The Coding Compliance Auditor performs internal medical record audits and prepares compliance auditing reports, subsequent educational materials and training as directed by the Compliance and Privacy department. Audits include regular compliance medical record audits or focused review projects for ongoing review of coding and documentation for cardiovascular specialties to support compliance with coding and documentation rules and regulations. Responsibilities: Performs coding audits reviewing for compliance and accuracy with CPT, ICD-10, HCPCS and corporate coding policy and follows up for timely completion within designated time period. Maintains excellent documentation of all reviews, methodologies employed, results, corrective...

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HCC Risk Adjustment Coder I

Regal Medical Group Los Angeles, CA

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...

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Inpatient Facility Medical Coder

Cedent Life Talent OR

Coding Auditor Senior Candidates must reside either in Washington or Oregon to be considered for this position. Essential Responsibilities: Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as needed for proper Ambulatory Payment...

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Medical Coding Compliance Specialist - Remote

Theoria Medical Novi, MI

Job Description Job Description Why Professionals Love Theoria Medical At Theoria Medical, accuracy, integrity, and collaboration matter. Our compliance and coding professionals play a critical role in supporting quality patient care while ensuring our clinical and billing practices remain aligned with evolving industry standards and regulations. We believe meaningful work should come with flexibility, support, and opportunities for growth. Our teams are empowered with advanced technology, collaborative leadership, and a mission-driven culture that values expertise and innovation. Build a career where your knowledge drives impact across a growing national healthcare organization. About Theoria Theoria Medical is leading the charge in healthcare innovation and quality of care — offering a unique blend of medical excellence and technological advancement, serving the post-acute sector. Our network includes multispecialty physician services covering skilled nursing...

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Coding Auditor, Facility

Scout Exchange OR

Title - Coding Auditor Location - Clackamas, OR Job Type - Permanent Job Summary: 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),...

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

Memorial Healthcare System Hollywood, FL

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 determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural...

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Quality Assurance Coder/Auditor - Hybrid

Blue Cross Blue Shield of Arizona Phoenix, AZ

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,...

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Coder I - MPG - FT - Days - MSS - Remote Eligible

Memorial Healthcare System United States

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: Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data. Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing). May assign and sequence basic CPT (Current...

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Inpatient Coding Compliance Auditor - HIM - FT - Days - Remote Eligible

Memorial Healthcare System United States

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: Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines. Responsibilities: Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of...

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

Memorial Healthcare System United States

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.For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors...

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Coder I - MPG - FT - Days - MSS - Remote Eligible

Memorial Healthcare System United States

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: Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data. Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing). May assign and sequence basic CPT (Current...

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Compliance Auditor, Billing and Coding Compliance

UT Health San Antonio San Antonio, TX

Compliance Auditor, Billing and Coding Compliance The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and...

UH

Sr Risk Adjustment Coder

University HealthCare Alliance Newark, NJ

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. 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 other departments to address coding updates and support risk...

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HCC Coder

TEKsystems Los Angeles, CA

HCC Auditor / Coder – Job Description The HCC Auditor/Coder is responsible for improving the accuracy and quality of provider documentation and reporting of chronic health conditions. This role supports risk adjustment initiatives through medical record audits, coding review, provider education, and ongoing collaboration with internal teams and provider offices. Key Responsibilities Audit provider medical records and super bills for accurate and compliant diagnosis and procedure coding Review a wide variety of document types, including primary and specialty care, inpatient, outpatient, mental health, substance abuse, ancillary, laboratory, and pharmaceutical services for HCC values Conduct both on‑site provider office audits and remote/online audits through medical record review Interface professionally with physicians and office staff to address coding questions and discrepancies Research and resolve coding issues using internal and external error reports Provide education...

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Risk Adjustment Compliance Auditor (Remote)

Alignment Healthcare United States

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Alignment Health is seeking a remote Risk Adjustment Compliance Auditor to support auditing and compliance activities related to risk adjustment data submitted to CMS. In this role, you will conduct provider and coder-level audits, review medical record documentation and coding accuracy, identify compliance risks and outliers, and support RADV...

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HCC Risk Adjustment Coder Sr.

Regal Medical Group Los Angeles, CA

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...

130 coder auditor risk adjustment jobs found