44 risk adjusted coder jobs found

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...

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose Codes, abstracts and analyzes inpatient and/or outpatient medical records using the most current International Classification of Diseases, Tenth Revision (ICD-10) for CMS risk adjustment purposes. Responsibilities Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10). Always coding to the highest level of specificity. Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines. Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines. Understands the impact of ICD-10 codes on the CMS HCC risk...

Resp & Qualifications Acts as an internal expert to ensure that as value‑based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing and contracting rules knowledge to build effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity. Provides expertise and mentoring to other team members. Purpose We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location...

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...

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose Codes, abstracts, and analyze inpatient and/or outpatient medical records using the most current International Classification of Diseases, Tenth Revision (ICD-10) for CMS risk adjustment purposes. Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10). Always coding to the highest level of specificity. Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines. Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines. Understands the impact of ICD-10 codes on the CMS HCC risk adjustment model....

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 largest...

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...

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...

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 largest...

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...

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Codes, abstracts and analyzes inpatient and/or outpatient medical records using the most current International Classification of Diseases, Tenth Revision (ICD-10) for CMS risk adjustment purposes. Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10). Always coding to the highest level of specificity. Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines. Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines. Understands the impact of ICD-10 codes on the CMS HCC...

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Codes, abstracts and analyzes inpatient and/or outpatient medical records using the most current International Classification of Diseases, Tenth Revision (ICD-10) for CMS risk adjustment purposes. Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10). Always coding to the highest level of specificity. Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines. Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines. Understands the impact of ICD-10 codes on the CMS HCC risk...

Job Title:Billing/Coding Specialist Department:My Kidney Center Reports To:Administrator/Medical Director FLSA Status:Non-Exempt Employment Status:Full-time or part-time Summary of Duties:The Medical Billing Specialist is responsible for managing patient account payments, including collecting, posting, and submitting claims to insurance companies.This role also involves following up on claims and resolving any billing issues.Essential Functions:1.Prepare and submit clean claims to various insurance companies, either electronically or by paper.2.Conduct insurance verification for prior authorizations and update insurance information.3.Answer questions from patients, clerical staff, and insurance companies.4.Identify and resolve patient billing complaints.5.Prepare, review, and send patient statements.6.Evaluate patients' financial status and establish budget payment plans.Follow up on delinquent accounts and report their status.7.Prepare information for the collection...

Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge to build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity. Provides expertise and mentoring to other team members. We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a...

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...

Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge to build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity. Provides expertise and mentoring to other team members. We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at 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...

Certified Risk Adjustment Coder Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God's love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care. Responsibilities & Requirements Job Overview: The Certified Risk Adjustment Coder is responsible for reviewing the ambulatory records for the appropriate risk adjustment components. The Risk Adjustment Coder will identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes. The Risk Adjustment Coder will leverage the MEAT (Monitor, Evaluate, Assess, Treat) criteria for accurate documentation by providers. When appropriate, the Risk Adjustment Coder will query...

Job Details Physician Office | Kettering | Full-Time | First Shift Responsibilities & Requirements Job Overview: The Certified Risk Adjustment Coder is responsible for reviewing the ambulatory records for the appropriate risk adjustment components. The Risk Adjustment Coder will identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes. The Risk Adjustment Coder will leverage the MEAT (Monitor, Evaluate, Assess, Treat) criteria for accurate documentation by providers. When appropriate, the Risk Adjustment Coder will query providers to clarify the HCC codes placed, inquire on additional documentation to support the HCC code placed, or discuss overall opportunities within the record. The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records. The Risk Adjustment Coder...

The Hospital Inpatient Coding Specialist reviews inpatient medical records and assigns International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10CM) diagnosis and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10‑PCS) procedure codes that derives an All Patient Refined Diagnosis Related Group (APR‑DRG) or Medical Severity Diagnosis Related Group (MS‑DRG) for optimal reimbursement. The Hospital Inpatient Coding Specialist will work in collaboration with the Clinical Documentation Integrity Specialist at times to ensure accuracy consistent with Centra’s coding policies. The Hospital Inpatient Coding Specialist will abstract pertinent information according to established guidelines for the organization and will formulate provider queries to clarify information. Responsibilities Assigns diagnosis and procedure codes. Verifies accuracy of DRG Accurately abstracts required information. Initiates provider coding...

Western Growers Health — a part of Western Growers Family of Companies — provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry. Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today! Compensation: $46,669.19 - $65,668.50 with a rich benefits package that includes profit‑sharing. This is a remote position and can reside...

Medical Coding Auditor - Must have a NM Residence UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a REMOTE, full-time, day shift opening located in Albuquerque, New Mexico. *This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico* *This position requires extensive knowledge and experience with E/M coding. *$4,000 Sign-on Bonus* Minimum $56,173 - Midpoint $70,217* *Salary is determined based on years of total relevant experience. *Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and...

Certified Professional Coder- Medical Biller Certified Professional Coder- Medical Biller 2 days ago Be among the first 25 applicants Women's Health Connecticut provided pay range This range is provided by Women's Health Connecticut. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $27.00/hr - $29.00/hr Direct message the job poster from Women's Health Connecticut Talent Acquisition Specialist II at Women's Health Connecticut Women’s Health Connecticut is seeking to hire a Full-time, Certified Professional Coder (CPC)- Medical Biller at our corporate business office in Rocky Hill, CT. Position : Certified Professional Coder (CPC)- Medical Biller Location : Women's Health CT- HQ Working arrangement : Hybrid, 2-3 days per week in-office Employment Type : Full-time, 40 hours per week Schedule : Monday- Friday Reports to : Director of Revenue Cycle Management Position Summary: The CPC-Medical Biller is responsible for...

Location: 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148 Compensation: $19.00 - $22.00 / hour Department: Billing - Central Description We are seeking a highly organized, detail-oriented Billing Specialist to support accurate, timely, and compliant revenue cycle operations. This role plays a critical part in ensuring clean claim submission, efficient denial resolution, and optimal reimbursement across multiple payer lines of business. The ideal candidate thrives in a fast‑paced healthcare environment, understands both front‑end and back‑end billing workflows, and is committed to accuracy, collaboration, and continuous process improvement. Experience with value‑based care and risk‑adjusted payment models is strongly preferred. This position directly supports our mission of improving patient outcomes while maintaining financial integrity within the healthcare system. Our Values Putting Patients First Operating with Integrity & Excellence Being Innovative Working as One Team What...