43 risk adjustment coder jobs found

Paycom - ATS is seeking a Risk Adjustment Coder Specialist to ensure accurate medical diagnosis data submission to CMS for CenCal Health Medicare Advantage D-SNP. You will optimize documentation, oversee vendor coding, and educate providers on risk adjustment standards. The role requires expertise in CMS risk models, ICD-10-CM guidelines, and strong collaboration with clinical and analytics teams to enhance risk adjustment outcomes. #J-18808-Ljbffr

Risk Adjustment Coder Specialist Main Office - Santa Barbara, CA 93110 Start Date 10/02/2026 Overview Salary Range $31.17 - $45.20 Hourly Position Type Full Time Category Financial Analytics Description Central Coast Salary Range: $31.17 - $45.20 Job Summary The Risk Adjustment Coder Specialist ensures accurate medical diagnosis data submission to CMS for CenCal Health Medicare Advantage D-SNP line of business. This role optimizes diagnosis documentation, identifies barriers to appropriate risk adjustment, oversees outsourced vendor coding for CMS compliance, and partners with provider outreach teams to educate providers on accurate and comprehensive medical coding. Duties & Responsibilities Perform reviews of records to identify, validate, and ensure accurate capture of diagnosis codes aligned with CMS-HCC, HHS-HCC, ICD-10-CM and applicable risk adjustment requirements. Oversee vendor coding activities, including monitoring work quality, reviewing vendor...

Job Description Job Description Primary Purpose: Support the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures in Risk Adjustment, CMS 5 Star, and the commercial and Medi-Cal programs. Principal Duties and Responsibilities (* = essential functions): Outreach and coordinate care for IPA members who need preventative and/or chronic care services such as mammograms, colonoscopies, uncontrolled HbA1c, uncontrolled blood pressure, etc. Collaborate with Risk Adjustment and quality on provider education. Maintain knowledge of clinical initiatives and risk adjustment program requirements Maintain knowledge of 5 Star performance and risk adjustment factors for all IPAs. Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports. Coordinate outreach to PCP offices on member due reports, including the No Annual Visits list. Provide PCP offices with...

Astrana Health, Inc. is seeking a Certified Risk Coder to support value‑based care and risk adjustment through accurate diagnoses, coding reviews, and CMS guideline compliance with clinicians. This remote US‑based role requires CRC credential and 2+ years in risk adjustment or HCC coding, ICD‑10‑CM proficiency, and experience with EHRs. Salary ranges from $56,000 to $85,000 annually, with West/Central time zone preference. #J-18808-Ljbffr

NECC is seeking a detail‑oriented HCC Coder to ensure accurate outpatient coding and documentation. You will work with Billing and Medical Director to apply ICD-10-CM, CPT, HCPCS and HCC guidelines, promoting quality measures and risk adjustment accuracy. You will review records for accuracy, educate staff on Medicare rules, and lead coding process improvements, with travel up to 10% for facility coverage as needed. #J-18808-Ljbffr

Job DescriptionJob DescriptionPrimary Purpose:Support the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures in Risk Adjustment, CMS 5 Star, and the commercial and Medi-Cal programs.Principal Duties and Responsibilities (* = essential functions):Outreach and coordinate care for IPA members who need preventative and/or chronic care services such as mammograms, colonoscopies, uncontrolled HbA1c, uncontrolled blood pressure, etc.Collaborate with Risk Adjustment and quality on provider education.Maintain knowledge of clinical initiatives and risk adjustment program requirementsMaintain knowledge of 5 Star performance and risk adjustment factors for all IPAs.Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports.Coordinate outreach to PCP offices on member due reports, including the No Annual Visits list.Provide PCP offices with ongoing education on quality measuresWork...

Job Title Support the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures in Risk Adjustment, CMS 5 Star, and the commercial and Medi-Cal programs. Principal Duties and Responsibilities (* = essential functions): Outreach and coordinate care for IPA members who need preventative and/or chronic care services such as mammograms, colonoscopies, uncontrolled HbA1c, uncontrolled blood pressure, etc. Collaborate with Risk Adjustment and quality on provider education. Maintain knowledge of clinical initiatives and risk adjustment program requirements Maintain knowledge of 5 Star performance and risk adjustment factors for all IPAs. Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports. Coordinate outreach to PCP offices on member due reports, including the No Annual Visits list. Provide PCP offices with ongoing education on quality measures Work...

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...

A healthcare organization in California is seeking a Medical Coder to perform chart reviews, coding audits, and provide training on ICD-10 codes. The ideal candidate will have an AA or AS degree, relevant coding credentials, and two years of healthcare experience. Responsibilities include coding audits, maintaining knowledge of coding guidelines, and assisting with billing inquiries. This role offers competitive benefits including free medical, dental, and vision insurance. #J-18808-Ljbffr

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,...

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...

Professional Fee Coding Auditor At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization. PRIMARY JOB DUTIES Audit Responsibilities Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD-10-CM, and payer...

Job Description Job Description Description The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement. Our Values:  Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Review medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and...

Job Description At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre‑billing coding edits, and reviewing post‑billing coding‑related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer‑specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization. Primary Job Duties Audit Responsibilities Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer policies....

Professional Fee Coding AuditorAt NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials.This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization.PRIMARY JOB DUTIESAudit ResponsibilitiesPerforms routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee.Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD-10-CM, and payer...

Professional Fee Coding Auditor At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization. PRIMARY JOB DUTIES Audit Responsibilities Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD-10-CM, and payer...

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. This position will support risk adjustment code validation for CMS and HHS Risk Adjustment models. Job Description : EDUCATION: HS Diploma or General Education Diploma (GED) CERTIFICATION & LICENSURE:...

Certified Risk CoderThe Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement.Our Values:Put Patients FirstEmpower Entrepreneurial Provider and Care TeamsOperate with Integrity & ExcellenceBe InnovativeWork As One TeamWhat You'll DoReview medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and compliance with CMS guidelinesPerform retrospective and...

Risk Adjustment Coding AuditorHuntington Beach Office - Huntington Beach, CA 92647OverviewSalary Range $72,800.00 - $80,000.00 Salary Position Type Full TimeDescriptionAre you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values.Why Join Us? We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.Job SummaryThe Risk Adjustment Coding...

Certified Risk Coder Department: Quality - Risk Adjustment Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation: $56,000 - $85,000 / year Description The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement. What You'll Do Review medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and compliance...

HCC CoderAdministration Office - Alhambra, CA 91801OverviewSalary Range $34.00 - $39.00 HourlyDescriptionPosition SummaryThe HCC Coder will be responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. The HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services.Schedule:Full-time (Non-Exempt)Flexible, may require some evening and weekendsPrimary Duties and ResponsibilitiesReview of medical records to ensure accuracy and claims for proper documentation and coding and completeness.Communicate with providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes.Create training...

Job Description The HCC Coder will be responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. The HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services. Schedule Full-time (Non-Exempt) Flexible, may require some evening and weekends Primary Duties and Responsibilities Review of medical records to ensure accuracy and claims for proper documentation and coding and completeness. Communicate with providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes. Create training presentations to educate staff in Medicare coding guidelines, with focus on Quality Measures...

HCC Coder Administration Office - Alhambra, CA 91801 Overview Salary Range $34.00 - $39.00 Hourly Description Position Summary The HCC Coder will be responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. The HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services. Schedule: Full-time (Non-Exempt) Flexible, may require some evening and weekends Primary Duties and Responsibilities Review of medical records to ensure accuracy and claims for proper documentation and coding and completeness. Communicate with providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for...