250 risk adjustment auditor coder jobs found

RadNet, Inc. is seeking experienced HCC Risk Adjustment Auditors/Coders in Los Angeles. Responsibilities include maintaining and monitoring quality assurance auditing plans and improving coding documentation accuracy. The role requires collaboration with healthcare providers and auditors to ensure compliance with coding classifications, such as ICD-9-CM and ICD-10-CM. Candidates must possess relevant certifications and strong proficiency in Excel and medical record auditing. The position offers a competitive pay range of $33-$36 per hour, along with a comprehensive benefits package. #J-18808-Ljbffr

Hcc Risk Adjustment Auditor/Coder, Sr. We are looking for experienced HCC Risk Adjustment Auditors/Coders, Sr. 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...

Stanford Health Care is seeking a Senior Risk Adjustment Coder in Newark, NJ, responsible for code audits and abstraction in line with regulations. This role requires collaboration with clinicians to ensure accurate coding and compliance initiatives. Applicants should have over 5 years of experience with coding guidelines, preferably in a healthcare setting. Stanford Health Care values diversity and encourages qualified applicants from all backgrounds to apply. #J-18808-Ljbffr

Alignment Health is seeking a skilled coder for a hybrid position based in Orange, CA. The ideal candidate will have at least 3 years of coding experience in a medical setting and expertise in Risk Adjustment. This position is vital for maintaining coding quality and implementing educational tools for providers. The role involves auditing code accuracy, compliance tracking, and coordinating training activities, all while contributing to a team committed to changing the lives of seniors. #J-18808-Ljbffr

E2E Alignment Healthcare USA, LLC is seeking a Medical Risk Adjustment Coding Auditor to conduct quality assessments and audits on coding performed by internal analysts and vendors to ensure accurate data submission to CMS. This fully remote role requires a minimum of three years' experience in Medicare Risk Adjustment coding as well as a certification as a medical coder. The successful candidate will also analyze audit results to train staff and improve processes, while ensuring compliance with regulations. #J-18808-Ljbffr

Our client is seeking an experienced Quality Assurance Coder/Auditor in Phoenix, AZ on a Hybrid basis. This opportunity will transition from a 6-month contract to direct hire position while being trained as a replacement by a seasoned employee. The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets. Schedule 40 hours a week (plus any additional hours as requested or as needed to meet business requirements). Hybrid 1 day a week in office setting, remainder of week is remote Key Responsibilities Comprehensive understanding of HCC Coding rules, regulations and methodology Review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct coding, and recommend best...

Alignment Health is a remote company focused on senior care. The Medical Risk Adjustment (MRA) Coding Auditor role supports departmental quality assessment audits of internal coding analysts and vendors to ensure accurate and complete data submission to CMS. General Duties / Responsibilities Supports regular quality assurance audits of the internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy), ensuring coding quality and performance improvement standards are maintained. Tracks and reports progress of QA audits performed on coding vendors to verify coding accuracy and quality of data submitted to AHP for CMS submission. Works with Risk Adjustment Management on any MRA data validation or coding audit to ensure completeness and coding accuracy of all CMS submissions; this may include data reconciliation, data flow integrity, UAT testing, review of high‑cost/low‑risk score members, retrospective chart reviews, or other related data...

Location Miramar, Florida 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 and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding. Submits daily productivity report to HIM manager by defined deadline....

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 billing...

Valley Medical Center in Renton is looking for a Risk Adjustment Auditor and Physician Educator responsible for conducting quality assurance reviews of medical record documentation related to Hierarchical Condition Categories (HCC) coding. The ideal candidate will develop strategies for education and training, ensuring accurate coding practices and compliance. This role requires a Bachelor's degree in health sciences and CPC certification, with a minimum of 3 years of experience in coding and medical record review. Strong analytical and critical thinking skills are essential. #J-18808-Ljbffr

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firms private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, workers compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions.The Advisory Group is currently accepting applications for a Certified Coding Auditor to work in its New York office or remotely.Principal duties and Responsibilities:Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payers.Researching state and payer...

## CMS HCC Coder - Hybrid remote - Orange, CA.Applyremote type: Hybrid Remotelocations: Orange, CAtime type: Full timeposted on: Posted Yesterdayjob requisition id: R2056Alignment 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.This position is hybrid- remote in Orange, CA. The Hierarchical Condition Categories (HCC) Coding Analyst will effectively interface with provider partners, to successfully, monitor...

Inpatient Facility Medical Coder (OR; WA) 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...

Job Description Job Schedule This role offers a hybrid schedule. You will need to visit two centers twice a week: one day at the Ocoee center and one day at the East Colonial center. These onsite visits are mandatory and non-negotiable. The remaining days of the week will be remote work. Job Summary The Medicare Coder Specialist facilitates modifications to clinical documentation through pre‑visit and post‑visit interaction with providers and other members of the healthcare team. She or he promotes capture of clinical severity (later translated into coded data) to support the level of service rendered to relevant patient populations, enhance evidence‑based medicine, promote continuity of care, and improve capturing chronic conditions. Responsible for coding all medical services procedures CPT and HCPCS codes, pharmaceuticals supplies, patients’ ICD‑10 diagnoses, signs, and symptoms when applicable, ensuring that all assigned ICD‑10‑CM codes are supported by proper clinical...

To ensure the accuracy of HCC coded records, the full-time remote HCC Coding Quality Specialist (Auditor) will review coding compliance with Medicare and ICD-10-CM guidelines, support coder education on findings, and maintain a quality score of 95% or higher. Key responsibilities: Review HCC coded records for compliance with Medicare and ICD-10-CM guidelines Support coders by clearly identifying errors and providing educational feedback Assist in creating training materials and presentations for the HCC coding team Required qualifications: Certification through AAPC or AHIMA (CPC, CRC, CCS, or CCS-P) is mandatory At least 3 years of HCC coding experience and 2 years of auditing experience Global experience in HCC auditing is preferred Working knowledge of EMRs, billing systems, and abstraction platforms Ability to maintain compliance with privacy and security regulations

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 physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.Responsibilities:Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and...

We are looking for experienced HCC Risk Adjustment Auditors/Coders, Sr. 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...

Blue Cross and Blue Shield of Minnesota is looking for a Risk Adjustment Coding Auditor. The role ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices. Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements. Performs retrospective and prospective chart reviews to ensure accurate risk adjustment reporting. Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider‑reported diagnosis codes based on medical record documentation. Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories. Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with...

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.Day - 08 Hour (United States of America)This is a Stanford Health Care - University Healthcare Alliance job.A Brief OverviewThe 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.LocationsStanford Health Care - University Healthcare AllianceWhat you will doRisk Adjustment ReviewMay perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditingReviewing medical records to ensure accurate HCC coding and...

Medical Coding & Risk Adjustment Auditor (Remote Contract) Location: Remote Duration: 6+ Month Contract Client: New Jersey-Based Healthcare Organization Position Summary We are seeking an experienced Medical Coding & Risk Adjustment Auditor to support a healthcare client's Risk Adjustment and Data Validation initiatives. This role is responsible for reviewing, interpreting, auditing, coding, and analyzing medical record documentation to ensure diagnosis accuracy, proper documentation, and Hierarchical Condition Category (HCC) abstraction. The position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation (RADV) audits, as well as ongoing Risk Adjustment activities across Medicare, Medicaid, and Commercial lines of business. Key Responsibilities Review, interpret, and translate CPT, HCPCS, ICD-9, and ICD-10 codes for HCC abstraction. Audit medical records for completeness, accuracy, and compliance with applicable...

MRA Coding Auditor 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. This is a remote position. General Duties/Responsibilities Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy). These ongoing audits ensure coding quality & performance improvement standards are maintained,...

Company Overview 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. Job Summary 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...

HCC Auditor (Humana Experience Required) – Contract (3–6 Months) We are seeking experienced HCC Auditors with Humana experience to support a HCC coding project. This contract assignment will run approximately 3–6 months with full‑time hours (minimum 40 hours per week). Role Overview The Auditor Specialist will perform quality assurance reviews on coded medical charts according to client‑specific guidelines. This role requires strong accuracy, adaptability, and the ability to work independently in a fast‑paced remote environment. Key Responsibilities Audit coded charts assigned by the Quality Supervisor following client‑specific guidelines Navigate multiple client guideline sets with minimal difficulty Maintain 95%+ accuracy at the diagnosis level Respond to rebuttals submitted by coders or auditors Participate in weekly project review meetings Complete additional tasks as assigned by the Quality Project Manager Required Qualifications Humana experience is required High school...

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firm's private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, worker's compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions.The Advisory Group is currently accepting applications for a Certified Coding Auditor to work in its New York office or remotely.Principal duties and Responsibilities:Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payers.Researching state and payer...