31 risk adjusted coder jobs found

How You’ll Make An Impact At Strive Health, patients come first. We’re on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You’ll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday. If you’re looking for meaningful work where your contributions truly matter, you’ll feel right at home at Strive! Benefits & Perks Hybrid-Remote Flexibility – Work from home while fulfilling in-person needs at the office, clinic, or patient home visits. Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts. Financial & Retirement Support –...

Risk Adjustment Auditor The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. Key Responsibilities: Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines. Identify unsupported diagnoses, over coding, under-coding, and documentation gaps. Provide detailed audit findings and recommendations to coding teams, providers, and leadership. Monitor compliance with CMS Risk Adjustment Data Validation...

About the job Remote | Certified Medical Coding Specialist - $40-$60/hour We are sharing a specialised part-time consulting opportunity for certified medical coders with strong expertise in CPT, ICD-10, clinical documentation review, and US healthcare coding standards. This high-volume project focuses on accurately coding medical records and clinical documentation while maintaining strong quality, compliance, and productivity standards. Selected professionals will assign appropriate codes, review documentation for completeness, identify discrepancies, and collaborate with quality teams to support consistent coding outcomes. Key Responsibilities Medical Record Coding Assign accurate CPT and ICD-10 codes to medical records and clinical documentation Apply appropriate coding conventions across varied healthcare encounters Review clinical information carefully before determining final code assignments Maintain accuracy across high-volume coding workflows...

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process. Department: Health Information Management Shift/schedule: Full Time (40 hrs/wk) GENERAL SUMMARY Works under the supervision of the HIM Manager (Operations & Auditing). The primary function of the HIM Coder - Professional is to code and charge medical office visits for professional claims. Must be able to review and edit charges in Meditech as well as review leveling criteria for E/M charging accuracy, charge for procedures and other billable services provided in the clinic/office setting. Must be able to code ICD-10 diagnoses and CPT codes while ensuring they are assigned correctly and sequenced appropriately. Must apply HCC/risk coding concepts to ensure the appropriate risk score is assigned to each patient. Must understand the basic ICD-10 diagnosis and CPT procedure coding rules and guidelines. Performs other duties as assigned....

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...

Brief Description: Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. Our main campus is located on 20+ acres just north of mid‑town Miami and houses support departments such as Finance, Accounting, Human Resources, Marketing, and more. Join us to do purposeful work with a diverse and respectful team. Job Title: HCC Risk Adjuster and Coder Job Summary: Reviews medical records and accurately codes and sequences diagnosis in order to obtain maximum reimbursement. Essential Job Functions Audit PACE medical records to ensure accuracy upon enrollment and disenrollment, and assign appropriate HCC codes per established department guidelines. Perform follow‑up coding of medical records resulting from internal and external reviews that identify coding discrepancies. Meet with PACE providers via MS Teams to assist with documentation improvement tied to reimbursement. Assist with other department duties as necessary....

Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. Our main campus is located on 20+ acres just north of mid‑town Miami, and is home to our support departments like Finance, Accounting, Human Resources, Marketing and more. Location: 5200 Northeast 2nd Avenue, Miami, FL, 33137, United States Employee Type: Full‑Time Contact Information: Miami Jewish Health Talent Team, Phone: 3057518626 Job Title HCC Risk Adjuster and Coder Job Summary Reviews medical records and accurately codes and sequences diagnosis in order to obtain maximum reimbursement. Essential Job Functions Audits PACE medical records to ensure accuracy, upon enrollment and disenrollment, and assigns appropriate HCC codes per established department guidelines Performs follow up coding of medical records as a result of internal and external reviews which identify coding discrepancies Meets with PACE providers via MS Teams to assist with...

Miami Jewish Health in Miami, FL is seeking an experienced HCC Risk Adjuster and Coder to review medical records, code diagnoses, and sequence codes to maximize reimbursement. The role requires an Associate degree in Health Information Management and at least 1 year of risk adjustment coding experience. You will audit records, collaborate via MS Teams with PACE providers, and support department duties in a fast-paced environment. #J-18808-Ljbffr

Brief Description: Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. Our main campus is located on 20+ acres just north of mid‑town Miami and houses support departments such as Finance, Accounting, Human Resources, Marketing, and more. Join us to do purposeful work with a diverse and respectful team. Job Title: HCC Risk Adjuster and Coder Job Summary: Reviews medical records and accurately codes and sequences diagnosis in order to obtain maximum reimbursement. Essential Job Functions Audit PACE medical records to ensure accuracy upon enrollment and disenrollment, and assign appropriate HCC codes per established department guidelines. Perform follow‑up coding of medical records resulting from internal and external reviews that identify coding discrepancies. Meet with PACE providers via MS Teams to assist with documentation improvement tied to reimbursement. Assist with other department duties as...

Miami Jewish Health is seeking an HCC Risk Adjuster and Coder to review medical records and accurately code and sequence diagnoses to maximize reimbursement. The role requires a minimum of 1 year of HCC/ ICD-10-CM coding experience, an associate degree in health information management, and strong knowledge of medical terminology. You will audit PACE records, interface with providers via MS Teams, and support documentation improvement while maintaining confidentiality and accuracy. #J-18808-Ljbffr

Miami Jewish Health in Miami, FL is seeking an experienced HCC Risk Adjuster and Coder to review medical records, code diagnoses, and sequence codes to maximize reimbursement. The role requires an Associate degree in Health Information Management and at least 1 year of risk adjustment coding experience. You will audit records, collaborate via MS Teams with PACE providers, and support department duties in a fast-paced environment. #J-18808-Ljbffr

Medical Coder I At ClareMedica, exceptional is the standard. Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the ClareMedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we're working together to help seniors live happier, healthier, fuller lives. That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees' growth and wellness and where their full potential and value are realized. At ClareMedica, we're excited about great people like you. We're even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities. Opportunity awaits welcome to ClareMedica. We are seeking an accurate, detailed oriented Coder to join our team. You will play a key role in reviewing...

Integrative Emergency Services, LLC ("IES") is seeking a Coding Specialist with emphasis on auditing surgical services. The Coding Specialist is responsible for accurate professional fee coding and documentation review for assigned surgical service lines (URSA/NTCC/TSN). This role evaluates medical records to ensure proper CPT, HCPCS Level II, and ICD-10-CM code assignment in accordance with payer guidelines and regulatory standards. The Coding Specialist supports documentation integrity, identifies coding compliance risks (including undercoding, overcoding, and unbundling), and contributes to clean claim submission and optimal reimbursement through coding analysis, audits, and special projects. Candidates can work in either a hybrid or remote setting. If remote, must reside in a state IES operates in: AZ, CO, TX, OK, IN, MO, AL, SC, FL IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting...

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. **Sign-On Bonus - $4,000** 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. *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* 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 management codes, medical diagnoses and clinical procedures ensuring that accurate medical billing...

Coding Specialist Integrative Emergency Services, LLC ("IES") is seeking a Coding Specialist with emphasis on surgical services. The Coding Specialist is responsible for accurate professional fee coding and documentation review for assigned surgical service lines (URSA/NTCC/TSN). This role evaluates medical records to ensure proper CPT, HCPCS Level II, and ICD-10-CM code assignment in accordance with payer guidelines and regulatory standards. The Coding Specialist supports documentation integrity, identifies coding compliance risks (including undercoding, overcoding, and unbundling), and contributes to clean claim submission and optimal reimbursement through coding analysis, audits, and special projects. Candidates can work in either a hybrid or remote setting. If remote, must reside in a state IES operates in: AZ, CO, TX, OK, IN, MO, AL, SC, FL. IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and...

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...

JOB DESCRIPTION SUMMARYPosition reports to the Supervisor Benefit Distribution & Installation and performs in-depth pharmacy and medical plan coding of new and existing business accounts. This position will ensure that all new and existing health (medical/dental/pharmacy) insurance plans underwritten by Western Growers Assurance Trust (WGAT) and those of Pinnacle Claims Management, Inc. (PCMI) are in compliance with the respective employers’ summary plan descriptions.DUTIES AND RESPONSIBILITIESPlan CodingPlan code new business and plan changes.Verify new and existing plans loaded on the company’s claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments.Respond to work orders received from examiners to investigate plan issues and irregularities.Evaluate testing requests for all new plans prior to loading them into the production system.AdministrativeKeep a detailed log of open and completed...

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. *$2,000 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...

Audit and Coding Specialist Westminster, Colorado We're Excited You're Here! Looking to join a compassionate community dedicated to providing exceptional mental health outcomes? Community Reach Center is that place. We prioritize empowering individuals living with mental health conditions, engaging with partners to make a lasting impact, and caring for our team on a personal level. Our mission is to enhance community health through evidence-based practices and convenient service locations, ensuring the well-being of our consumers and communities. At Community Reach Center, we offer more than just a job – we provide an experience that nurtures personal and professional growth. Join us and gain the skills to pursue your dreams while finding fulfillment within our team! Employee's First Approach – At Community Reach Center, we prioritize an exceptional employee experience. We know that it's imperative to prioritize our employees needs first, so they can be their best...

Job Description Job Description Who We're Looking For… We're looking for a billing compliance professional who has been in the weeds; someone who has audited timekeeper entries line by line, pushed back on attorneys when entries didn't hold up, and written appeals that resulted in successful resolutions. You know your UTBMS codes. You know when a narrative is going to get cut before it ever reaches the carrier. And when the billing guidelines don't have a clear answer, you make a sound judgment call, in alignment with the spirit of carrier guidelines, and own it. This is a high-volume role with real variety, steady audit work, alongside special projects that require you to shift gears quickly, reprioritize, and perform at a high level under pressure. You'll work within a collaborative, fully remote team that communicates directly, respects each other's expertise, and expects everyone to bring their best. If you've spent years building expertise in this niche and you're...

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...

Billing Compliance Auditor (Law Firm Experience Required) San Diego, CA We're looking for a billing compliance professional who has been in the weeds; someone who has audited timekeeper entries line by line, pushed back on attorneys when entries didn't hold up, and written appeals that resulted in successful resolutions. You know your UTBMS codes. You know when a narrative is going to get cut before it ever reaches the carrier. And when the billing guidelines don't have a clear answer, you make a sound judgment call, in alignment with the spirit of carrier guidelines, and own it. This is a high-volume role with real variety, steady audit work, alongside special projects that require you to shift gears quickly, reprioritize, and perform at a high level under pressure. You'll work within a collaborative, fully remote team that communicates directly, respects each other's expertise, and expects everyone to bring their best. If you've spent years building expertise in this niche and...

Associate Director, Global Medical Oncology, Medical Communications, Hematology Working with Us Challenging. Meaningful. Life-changing. Those aren't words that are usually associated with a job. But working at Bristol Myers Squibb is anything but usual. Here, uniquely interesting work happens every day, in every department. From optimizing a production line to the latest breakthroughs in cell therapy, this is work that transforms the lives of patients, and the careers of those who do it. You'll get the chance to grow and thrive through opportunities uncommon in scale and scope, alongside high-achieving teams. Take your career farther than you thought possible. Bristol Myers Squibb recognizes the importance of balance and flexibility in our work environment. We offer a wide variety of competitive benefits, services and programs that provide our employees with the resources to pursue their goals, both at work and in their personal lives. Position Summary Position reports to...