27 risk adjustment coder jobs found

Medical billing and coding • santa rosa ca Last updated: 4 days ago $19.22 hourly Full-time Quick Apply PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center. Medical Records Director Location: Santa Rosa Post Acute, Santa Rosa, CA. Salary Range: $65,000-$75,000 annually. The Medical Records Director oversees the management, security, and accuracy of resident health records in com… Medical Assistant (MA II) The Medical Assistant (MA II) works under the delegation of a licensed practitioner to perform duties as directed to assist in providing patient care to assigned patients. A Medical Assistant (MA II…) … Medical Assistant – Various Campuses Various Campuses – Santa Rosa, CA 95401. Hourly Position Type Full Time. Job Summary: The Medical Assistant functions within the care team by assisting the medical provider, serving as a liaison betw…...

Sr. Associate, Health Care 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....

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II for Orange County. This role focuses on chart reviews to identify coding gaps and drive accuracy for Medicare Advantage, ACA, and commercial plans. You will educate providers, track KPIs like HCC recapture and AWVs, and work up to 75% travel to provider offices in Orange County. AAPC/AHIMA certification and 3+ years of risk adjustment experience are preferred. #J-18808-Ljbffr

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...

University HealthCare Alliance (dba Stanford Medicine Partners) is the medical foundation of Stanford Health Care and Stanford Medicine. Stanford Medicine Partners was born out of the aspiration for Stanford Medicine and local, leading providers to partner together to bring high-quality care to patients within surrounding communities. Together, we are committed to delivering outstanding, leading-edge care to our patients. How We Work With Stanford Health Care Anchored by Stanford Health Care and the Stanford School of Medicine, Stanford Medicine Partners is dedicated to providing the highest standards of clinical excellence in order to ensure access for Bay Area patients to leading providers, while contributing to Stanford University’s well-respected Stanford Hospital and Clinics’ transformation into a broader and more integrated regional health system. Together, SMP and Stanford are pioneering new ways to practice medicine across multiple locations, using Stanford’s advanced...

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 effectively with physicians and office staff on coding issues. Research coding questions as...

Astrana Health, Inc. in Orange, California, is looking for a Transitions of Care Pharmacist to support safe medication use during patient admissions and discharges. This role involves ensuring proper medication management to enhance patient safety. The ideal candidate will work under the supervision of the Clinical Pharmacy Program Manager, contributing to optimal medication therapy management as patients transition in and out of healthcare settings. #J-18808-Ljbffr

RadNet, Inc. is seeking a HCC Risk Adjustment/Auditor in Los Angeles, California. This role involves maintaining quality auditing plans for outpatient clinical data and ensuring compliance with coding standards. The ideal candidate should have knowledge in HCC coding, expertise in ICD-9-CM or ICD-10-CM, and excel in medical record audits. This position also offers a competitive pay range of $25 - $27 per hour, along with a comprehensive benefits package including health coverage and flexible spending accounts. #J-18808-Ljbffr

Astrana Health is seeking a motivated Risk Adjustment Coding Specialist to join their team in Orange, California. This role involves reviewing diagnostic data, providing training to provider staff, and coordinating with physicians on documentation procedures. Candidates must possess a coding certification and have 3-5 years of related experience. The position offers a hybrid work schedule requiring up to 75% travel and presents a compensation of $70,000 to $85,000 annually, depending on experience and location. #J-18808-Ljbffr

Astrana Health Management is seeking a Risk Adjustment Coding Specialist II to support the Orange County market. Candidates should have 3-5 years of risk adjustment coding experience and be able to travel up to 75% for the role. You will review provider documentation, conduct education sessions, and ensure compliance with coding regulations. AAPC or AHIMA certification is required. The role offers a competitive salary range of $70,000 - $85,000 per year. #J-18808-Ljbffr

Job DescriptionJob DescriptionSUMMARYThe Certified Risk Adjustment Coder is responsible for accurately abstracting provider services into ICD-10 codes from medical documentation.This role adheres to the coding ethics of organizations such as the American Academy of Procedural Coders (AAPC), American Health Information Management Association (AHIMA), and the National Alliance of Medical Auditing Specialists (NAMAS), as well as payer guidelines.The coder conducts concurrent, prospective, and retrospective reviews of medical record documentation to ensure the accurate and complete capture of the clinical picture, severity of illness, and complexity of patients.Additional duties include provider communication and education to support the closure of both risk adjustment and quality care gaps, as well as providing ongoing feedback to physicians regarding coding guidelines and requirements.ESSENTIAL JOB FUNCTIONSPerform coding quality audits of medical records to ensure ICD-10 codes are...

Medical Coding Specialist Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties: Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. Builds positive relationships between providers and the business by providing coding assistance as...

Health Coder - Hcc & Risk Adjustment Burlingame, CA 94010 Overview Salary Range $42.79 - $48.75 Hourly Description The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization's quality outcomes and financial performance. Essential Job Functions: Hcc Coding and Risk Adjustment (Ra) Program Support Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with Hcc and risk adjustment guidelines. Ensure all...

Health Coder - Hcc & Risk Adjustment Burlingame, CA 94010 Overview Salary Range $42.79 - $48.75 Hourly Description The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization's quality outcomes and financial performance. Essential Job Functions: Hcc Coding and Risk Adjustment (Ra) Program Support Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with Hcc and risk adjustment guidelines....

Job Details Job Location: Burlingame, CA 94010 Salary Range: $42.79 - $48.75 Hourly ESSENTIAL JOB FUNCTIONS HCC Coding and Risk Adjustment (RA) Program Support Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines. Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance. Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy. Provider Training and Clinical Documentation Improvement (CDI) Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding. Provide one‑on‑one and group training to providers and clinical staff to improve documentation quality and accuracy. Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards. Data Analysis and Reporting Analyze coding data to identify trends, documentation...

Job DescriptionJob DescriptionDescription :This is a flexible CMS HCC / Risk Validation Audit role for a seasonal project.Other opportunities for continued work may be available at the conclusion of the project.Flexible work hours - nights and weekends are acceptable.Coders will review member and claim data validation aspects, which include :Member name, Member DOB, Gender, Dates of service, claim type, and provider signatureCoders will be presented with all risk-adjusting diagnoses billed on a claim for a particular date of service or inpatient stayMust be able to identify acceptable provider specialtyCoder must have knowledge of ICD-10-CM IP and OP codingCoders will confirm or not confirm each diagnosisCoders will add risk-adjusting diagnoses that are valid but not reportedRequirements :Active certification through AAPC or AHIMA is requiredMinimum 5 years verifiable risk adjustment coding experience post certificationMust be able to maintain a 95% accuracy rate and 3 CPHUS-Based...

Riverside Medical Clinic in California is seeking a dedicated coder to handle coding and compliance processes related to CPT, HCPCS, and ICD. Candidates should have a minimum of one year experience in medical coding and possess a relevant medical coding certificate. This position offers growth and development opportunities within Universal Health Services (UHS) along with a competitive compensation package, making it a fulfilling environment for those passionate about quality healthcare. #J-18808-Ljbffr

Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills. Ability to perform job duties using an electronic medical record system. Strong knowledge of anatomy, physiology and medical terminology. Knowledge of coding classification systems and procedures. Required Work Experience: For HIM coder, one (1) year hospital-based outpatient coding experience. For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System. For HIM, Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) or Certified Coding Associate (CCA). For Physician Billing, Certified Professional...

Job Type Full-time Description About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: The Junior Quality Improvement Coder is responsible for providing director support to all departmental QI initiatives. In this role, the Junior QI Coder will partner with the Director to collaborate with network providers and IPA's to improve the quality of care through quality improvement activities that will include RAF, HEDIS, CMS Star Ratings and other health plan reporting. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Analyze data from contracted IPA network providers that allows...

Fully Remote role - Must reside in CA - CPC, CCS, or equivalent certification required. Specialty coding certification is highly desired. **ROLE REQUIREMENTS** Surgical breast oncology (including plastic reconstructive breast surgery), Hematology/Oncology Must be able to abstract the chart review to capture all billable charges EPIC experience: charge entry and charge review experience required Strong Evaluation and Management (E/M) inpatient and outpatient coding experience Must reside in CA but can be remote Profee ONLY - NOT HCC/risk adjustment, ASC, or facility coding Desire to convert to full-time employment **Bonus/nice to have** Bonus: GYNONC coding experience Bonus: Experience working on denials Bonus: GI (CGIC coding certification) or OBGYN (COBGC coding certification) coding experience (1 year or more) Job Description: Under the direction of the Coding Compliance Manager, the Specialty Physician Coder plays a key role in...

Our Client, a Healthcare company, is looking for a Senior Specialty Physician Coder - Interventional for their Fountain Valley, CA location. Responsibilities: Achievement of productivity standards as established by management. Achievement of quality standards as established by management. In adherence with standard work, analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS codes to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines, including the ability to review and natively code surgical operative and/or procedure reports. In adherence with standard work, follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark...

Junior Quality Improvement Coder Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. The Junior Quality Improvement Coder is responsible for providing director support to all departmental QI initiatives. In this role, the Junior QI Coder will partner with the Director to collaborate with network providers and IPA's to improve the quality of care through quality improvement activities that will include RAF, HEDIS, CMS Star Ratings and other health plan reporting. Essential Duties And Responsibilities Include The Following: Analyze data from contracted IPA network providers that allows for proper review of data to...

DRG Coder The Senior DRG Coder is responsible for reviewing inpatient medical records and accurately assigning diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS to determine the appropriate Diagnosis-Related Group (DRG) assignment. This role ensures coding accuracy, reimbursement integrity, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent Practice Association (IPA) and Management Services Organization (MSO) environment, the Senior DRG Coder partners with utilization management, care management, finance, and provider network teams to support accurate payment, risk adjustment, quality reporting, and medical expense analysis. What You'll Do Review inpatient hospital records and assign accurate diagnosis and procedure codes Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation Conduct coding validation and auditing to ensure compliance with payer and regulatory...

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...