149 crc certified risk adjustment coder jobs found

Description Summary: The HCC Coding Auditor will perform code audits and abstractions using the Official Coding Guidelines for ICD-10-CM and AHA Coding Clinic Guidance, following all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor will be involved with quality assurance auditing and risk adjustment code abstraction for the following programs: Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is a hybrid role. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Performs Medical Record reviews and audits based on organizational priorities. These can include prospective and concurrent Clinical Documentation Improvement (CDI) workflows and retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for...

Position: HCC Certified Coder The Monogram HCC Certified Coder will abstract clinical information and assign appropriate diagnosis and procedure codes in accordance with nationally recognized coding guidelines. The HCC Certified Coder will analyze and translate medical and clinical diagnoses, in adherence with the CMS Risk Adjustment Models. The successful candidate will work as a team with our coding team and providers. Primary duties include auditing patient health assessment, peer coding quality reviews, provider and coding team training and education. Performs medical chart audits on prospective basis to identify, monitor and document claims and encounter coding information as it relates to Hierarchical Condition Categories (HCC). Performs coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes and are adhering to CMS Risk Adjustment guidelines. Educates clinicians on specific coding issues found in...

Job Description Job Description Job Title: HCC Coder Department: Risk Adjustment Hours per week: 40 F/T or P/T status: Full time Schedule/Hours : M-F, 8 am - 5 pm Job Summary Coordinates/Supports retrospective and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract and validate medical record data. Minimum Qualifications: High school diploma or equivalent (GED). AAPC/AHIMA certification. CRC ® certification required within 1 year of employment. Job Posted by ApplicantPro

Optima Medical is an Arizona-based medical group consisting of 22 locations and 90+ medical providers, who care for more than 120,000 patients statewide. Our mission is to improve the quality of life throughout Arizona by helping communities “Live Better, Live Longer” through personalized healthcare, with a focus on preventing the nation’s top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard. Optima is currently seeking a HCC Risk Coder Specialist to join our team! As the Risk Adjustment Coder, you will perform medical record diagnosis code abstraction based upon clinical documentation, ICD-10-CM official guidelines for coding and reporting, CMS program...

Location: Work from home (Pennsylvania) Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: No Job Summary: Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. The coding process reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters. Coders are responsible for translating diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes that can be utilized for submitting claims to payers for reimbursement. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. Job Duties: Reviews the content of the medical records from multiple EHR's and on-site for both hospital and professional inpatient or...

Job Description Job Description Risk Adjustment Coder and Educator   Job Summary: The Risk Adjustment Coder & Educator is responsible for providing expertise in the area of risk adjustment coding for assigned provider groups. This includes reviewing medical records and identifying, collecting, assessing, monitoring, and documenting claims and encounter information as it pertains to risk adjustment for both Medicare and Commercial patient populations. The Risk Adjustment Coder & Educator interacts with Value Based Care (VBC) leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and coding. (This is a full-time position Monday to Friday 8 am to 5 pm)    Primary Job Responsibilities/Tasks may include, but not limited to:   Primary Responsibilities: Provides guidance and consultation to assist providers in...

Job Description Job Description Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one 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 with management to meet communicated single 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 Risk Adjustment processes. You will report to the Risk Adjustment Coding Lead. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our...

LaSalle Network has partnered with our client in the healthcare industry for an exciting HCC Coder opportunity! As an HCC Coder , you will be responsible for accurately coding patient diagnoses using ICD-10 and mapping them to Hierarchical Condition Categories (HCC). Your role will support risk adjustment and reimbursement processes, ensuring compliance with industry standards and regulations. We are looking for someone who has recently completed their apprenticeship and gained hands-on experience in HCC coding. HCC Coder Responsibilities: Review and analyze patient medical records to assign appropriate ICD-10 codes Map diagnoses to Hierarchical Condition Categories (HCC) to facilitate accurate risk adjustment Ensure adherence to coding guidelines, industry standards and regulatory requirements Collaborate with healthcare providers and clinical staff to obtain necessary documentation and resolve coding issues Conduct regular audits to ensure coding...

Sentara Health is seeking to hire a qualified individual to join our team as Risk Adjustment Coder. Position Status : Full-time, Day Shift Position Location: Hybrid work model – 1 day week on-site in Virginia Beach; initial onboarding & training will be in-office Standard Working Hours : 8:00AM to 5:00PM Overview This role consists of educating primary & specialty care providers and staff on appropriate HCC coding & documentation, via virtual sessions and in-person site visits. Duties include retrospective auditing to ensure compliance with appropriate HCC coding & documentation guidelines. Education Associate degree required in healthcare administration, nursing, health information management, accounting, finance, or other related field or In lieu of associate’s degree, 4 years of medical coding experience is required Certification/Licensure One of the following certifications are required: Certified Professional Coder (CPC), Certified Outpatient Coder (COC),...

City/State Virginia Beach, VA Work Shift First (Days) Overview: Sentara Health is seeking to hire a qualified individual to join our team as Risk Adjustment Coder . Position Details Position Status: Full-time, Day Shift Position Location: Hybrid work model - 1 day week on-site in Virginia Beach; initial onboarding & training will be in-office Standard Working Hours: 8:00AM to 5:00PM Role Overview This role involves educating primary & specialty care providers and staff on appropriate HCC coding & documentation through virtual sessions and in-person site visits. Responsibilities include retrospective auditing to ensure compliance with HCC coding & documentation guidelines. Education Requirements Associate degree required in healthcare administration, nursing, health information management, accounting, finance, or related field or 4 years of medical coding experience in lieu of an associate's degree Certification/Licensure Required certifications: CPC,...

Do you thrive in a fast-moving, detail-driven environment? We're looking for an enthusiastic Risk Adjustment Coder to join our client's vibrant team! You'll use your skills to accurately code patient diagnoses using ICD-10, mapping them to Hierarchical Condition Categories (HCC) to keep our client's risk adjustment and reimbursement processes running smoothly. Risk Adjustment Coder Responsibilities: Analyze and code patient medical records using ICD-10 Map diagnoses to HCC categories to ensure precise risk adjustment Collaborate with clinical staff to resolve documentation issues and improve workflow Conduct audits and stay on top of coding regulations and updates to maintain accuracy Provide expert coding guidance to your team when needed Risk Adjustment Coder Requirements: 2+ years of HCC coding experience post-apprenticeship Certification as a CPC, CCS, or similar? Even better! Deep knowledge of ICD-10 coding, HCC categories and risk...

We are so glad you are interested in joining Sutter Health! Organization: SHSO-Sutter Health System Office-Valley Position Overview: This position conducts review of outpatient medical records using International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid Services (CMS) coding and reporting guidelines. Performs medical record reviews to ensure accurate assignment of medical diagnoses and procedures. Responsible for pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses and to alert the physician of potential clinical conditions that may require review. Job Description : EDUCATION Equivalent experience will be accepted in lieu of the required degree or diploma. HS Diploma or equivalent education/experience CERTIFICATION & LICENSURE CRC-Certified Risk Adjustment Coder OR CPC-Certified...

Job Overview Responsible for auditing all Senior HMO members' medical records to ensure accuracy of Risk-Adjustment data and reimbursement. Maintain a professional, positive and caring attitude at all times Duties 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...

Job Posting Remote Extern – Medical Coding, Auditing & Compliance (AAPC Project Externship) Healthcare Inspired LLC – United States (fully remote) About Healthcare Inspired Healthcare Inspired is a woman-owned revenue-cycle consulting firm that partners with physician practices, ASCs, and hospital-based groups nationwide. Led by nationally recognized educator, author, and podcaster Jennifer McNamara , our AAPC- & AHIMA-credentialed team delivers end-to-end solutions in coding, auditing, credentialing, and business-intelligence reporting. We’re known for a “teach-as-we-work” culture that empowers—not replaces—client teams. Why This Externship? Our Project Extern rotation (approved through the AAPC Practicode/Extern program) drops you into real charts, policies, and payer scenarios—no busywork. You’ll: Abstract charts in orthopedics, general surgery, ENT, plastics, primary care, and pathology. Work live NCCI edit denial cases, draft appeal...

City/State Virginia Beach, VA Work Shift First (Days) Overview: Sentara Health is seeking to hire a qualified individual to join our team as Risk Adjustment Coder . Position Details Position Status: Full-time, Day Shift Position Location: Hybrid work model - 1 day week on-site in Virginia Beach; initial onboarding & training will be in-office Standard Working Hours: 8:00AM to 5:00PM Role Overview This role involves educating primary & specialty care providers and staff on appropriate HCC coding & documentation through virtual sessions and in-person site visits. Responsibilities include retrospective auditing to ensure compliance with HCC coding & documentation guidelines. Education Requirements Associate degree required in healthcare administration, nursing, health information management, accounting, finance, or related field or 4 years of medical coding experience in lieu of an associate's degree Certification/Licensure Required certifications: CPC, COC, CIC,...

Datavant is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring...

This is a full-time, remote position that offers a flexible schedule. Description: MedKoder, LLC is seeking a remote Professional HCC Risk Adjustment Coder who will apply both technical and specialized expertise to help healthcare programs remain compliant with government regulations while identifying opportunities for increased financial success. The HCC Risk Adjustment Coder provides coding services to health systems and insurance plans utilizing MedKoder’s coding platform. The primary function of this position is to perform ICD-10-CM coding for risk adjustment-eligible encounters. The HCC Risk Adjustment Coder ensures compliance with ICD-10-CM coding guidelines, AMA Coding Clinic guidance, and client-specific requirements. The HCC Risk Adjustment Coder must prioritize daily duties, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals. Responsibilities: Assign accurate ICD-10 codes based on documentation, ensuring...

Overview At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work. Must be located in Idaho, Oregon, Utah or Arizona! What You Can Expect: Under limited supervision, the Coder is responsible for reviewing applicable documentation and assigning appropriate procedure and diagnosis codes. Reviews notations, diagnosis, or procedure information in medical record to assign appropriate diagnosis and procedure codes, ensuring accuracy and appropriateness of codes. Applies knowledge of coding to solve unique or new cases resulting in the assignment and sequencing of diagnosis and procedure codes related to the...

LaSalle Network has partnered with our client in the healthcare industry for an exciting HCC Coder opportunity! As an HCC Coder , you will be responsible for accurately coding patient diagnoses using ICD-10 and mapping them to Hierarchical Condition Categories (HCC). Your role will support risk adjustment and reimbursement processes, ensuring compliance with industry standards and regulations. We are looking for someone who has recently completed their apprenticeship and gained hands-on experience in HCC coding. HCC Coder Responsibilities: Review and analyze patient medical records to assign appropriate ICD-10 codes Map diagnoses to Hierarchical Condition Categories (HCC) to facilitate accurate risk adjustment Ensure adherence to coding guidelines, industry standards and regulatory requirements Collaborate with healthcare providers and clinical staff to obtain necessary documentation and resolve coding issues Conduct regular audits to ensure coding accuracy and completeness...

City/State Virginia Beach, VA Work Shift First (Days) Overview: Sentara Health is seeking to hire a qualified individual to join our team as Risk Adjustment Coder. Position Status : Full-time, Day Shift Position Location: Hybrid work model - 1 day week on-site in Virginia Beach; initial onboarding & training will be in-office Standard Working Hours : 8:00AM to 5:00PM Overview This role consists of educating primary & specialty care providers and staff on appropriate HCC coding & documentation, via virtual sessions and in-person site visits. Duties include retrospective auditing to ensure compliance with appropriate HCC coding & documentation guidelines. Education Associate degree required in healthcare administration, nursing, health information management, accounting, finance, or other related field or Iin lieu of associate's degree, 4 years of medical coding experience is required Certification/Licensure One of the following certifications are required:...

Job Type: Full-TimeBenefits Offered:HealthcareDentalVisionPTO401KYour Job SummaryWe are looking for an experienced coder with the skill set to use medical codes to document patient diagnoses and treatments. Coders play a vital role in the connection between health care providers, patients and insurance companies. Specifically, the duties of the position include:Your Responsibilities:Review and analyze medical records to assign accurate ICD-10-CM diagnosis and ICD-10-PCS (if applicable) procedure codes.Ensure coding accuracy and compliance with CMS, Medicare, Medicaid, and state-specific requirements.Apply PDPM coding guidelines to optimize reimbursement in skilled nursing facilities (SNFs). Work closely with clinical staff, therapists, and providers to clarify and improve documentation for accurate coding.Conduct routine and random audits of facility coding practices to ensure accuracy and compliance.Identify coding errors, documentation deficiencies, and trends that may impact...

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 in providing 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 procedure codes....