24 risk adjustment coder jobs found

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be...

A leading health data company in Tallahassee, Florida is seeking an HCC coder to review medical records and ensure accurate coding for patient conditions. This critical role requires AHIMA or AAPC certifications and a minimum of 2 years of coding experience. Strong communication skills, flexibility, and a high degree of accuracy in coding are essential. The position offers competitive pay with performance-based incentives, and is open to candidates who can work effectively in a remote environment. #J-18808-Ljbffr

Datavant is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring...

Physicians' Primary Care of Southwest Florida is a premier physician-owned and managed multi-specialty practice with locations in Cape Coral, Estero, Fort Myers, and Lehigh Acres. We are currently seeking an in-house HCC Risk Adjustment Coder for our Compliance and Coding department located in Fort Myers. This is not a remote coding position, must reside in Lee County Florida . Schedule is Monday through Friday, Day Shift. Sample of Responsibilities: Perform prospective reviews and clinical documentation improvement opportunities Assist healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation The individual will conduct chart reviews to abstract data not submitted by providers Initiate opportunities to improve documentation Assists other team members as needed to meet the goals of the department. Maintain strictest confidentiality and adhere to all HIPAA guidelines and regulations. Position...

Job Description Job Description Please only submit an application if you live in one of these states: FL, VA, TX, NY, NJ, MO About Us At Greenbrook Medical, we believe seniors deserve more from the healthcare system—more time, more care, more coordination, and more heart. We provide high-touch, relationship-based primary care to seniors, built around one simple idea: deliver the kind of care we'd want for our own parents. Founded by two brothers inspired by their father's pioneering work in Medicare Advantage, Greenbrook is deeply personal and proudly modern. We quarterback our patients through their healthcare journey, making sure they're never alone in a complex system. Our business model is designed around patient outcomes, not volume—so we only succeed when our patients thrive. With roots in Tampa Bay and a partnership with Tampa General Hospital, we're growing thoughtfully to bring our model to more communities. Our team is the heart of it all: mission-driven,...

Responsible for providing coding quality auditing services and evaluating clinical documentation for all providers within the USFTGP organization. Establishes and provides timely communication of identified quality issues concerning documentation and coding with a target minimum of a 95% accuracy/passing rate. More specifically this team member will: Audit retro and concurrent medical provider clinical documentation while adhering to Medicare guideline • Review documentation to assign/audit correct diagnosis codes Identify areas for documentation improvement and effectively communicates with providers and staff. Perform in a professional manner, exercising good judgment and ethical standards. Interacts effectively and builds respectful working relationships across the organization. • Demonstrate integrity by adhering to high standards of personal and professional conduct. Comply with the Standards of Ethical Coding as set forth by the American Health Information...

Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. 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. Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts...

Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. 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. Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts...

Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. 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. Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts...

Coder II - Revenue Integrity Lee Health is seeking an experienced Medical Coder II Revenue Integrity to support accurate, compliant outpatient and professional fee coding across our health system. In this role, you will abstract detailed clinical, demographic, and statistical information from medical records and apply correct ICD-10-CM, CPT-4, and APC guidelines. This position plays a key role in our Reconciliation Reduction and Provider Education Project, partnering with Charge Review, reconciliation workflows, and data analysis tools to improve accuracy and financial integrity. The ideal candidate is a self-starter, highly analytical, skilled in communication, and comfortable presenting findings to leaders and providers. This role is primarily remote but requires the candidate to be local to the Fort Myers/Cape Coral area for periodic on-site training or meetings. Core Coding Functions Abstract data from medical records into Epic and Solventum/3M 360 to create accurate...

Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. 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. Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts...

Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. 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. Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts...

Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. 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. Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts...

Location: Miramar, Florida 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: 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...

Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. 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. Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts...

Job Description Job Description JOB TITLE: Coding Compliance Auditor REPORTS TO: Director of Billing and Credentialing FLSA STATUS: Non-Exempt JOB SUMMARY The Coding Compliance Auditor is responsible for conducting ongoing audits of provider documentation, coding accuracy, and revenue integrity to ensure compliance with federal and state regulations, payer guidelines, and internal policies. This role evaluates clinical documentation and coding practices to reduce risk, improve reimbursement accuracy, and support continuous compliance and quality improvement initiatives across the organization. QUALIFICATIONS / EDUCATION Associate or Bachelor’s degree in Health Information Management, Healthcare Administration, Nursing, or related field preferred. Minimum 2–3 years of experience in medical coding, auditing, or revenue cycle compliance required. Strong knowledge of CPT, ICD-10-CM, HCPCS, and modifier usage. Knowledge of Medicare, Medicaid, and commercial payer...

Location: Remote - FL Department: Coding Work Type: Full Time Shift: 1/8:00:00 AM to 4:30:00 PM Pay Rate: $20.50 - $27.85 / hour Remote position. Incumbents residing in Florida may work remotely. Occasional on-site work at assigned Lee Health location may be required. Summary Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments. Includes inpatient E/M coding and clinic E/M coding as well as trauma surgery coding and bedside procedure coding. Experience required in at least E/M coding or trauma surgery coding. Facility...

Join to apply for the MRA Coder role at Valora Medical Group Altamonte Springs, FL Essential Duties and Responsibilities Review and analyze patient medical records from primary care visits to identify and assign appropriate ICD-10-CM diagnosis codes. Validate documentation supports risk adjustment coding and HCC capture in compliance with CMS guidelines. Collaborate with primary care providers to clarify documentation, improve coding accuracy, and close care gaps. Conduct retrospective and concurrent risk adjustment coding reviews. Educate clinicians on documentation requirements for chronic conditions and HCC accuracy. Maintain up-to-date knowledge of coding guidelines, regulatory requirements, and payer risk adjustment programs. Assist with audits, quality reviews, and compliance monitoring related to risk adjustment coding. Track and report coding trends, errors, and provider documentation opportunities. Ensure compliance with HIPAA regulations and maintain...

Coder II - ProFee Surgery Location: Remote - FL Department: Coding Work Type: Full Time Shift: Shift 1/8:00:00 AM to 4:30:00 PM Minimum to Midpoint Pay Rate: $20.50 - $27.85/ hour This is a remote position. Incumbents, who reside in Florida only, may work remotely. There may be occasional situations that require work to be performed on-site at an assigned Lee Health location. Summary Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments. Professional Fee Specific: Responsible for coding Surgical Records, Evaluation &...

Summary/Objective Under limited supervision the Coder HCC reviews medical records and performs coding on all diagnoses, procedures, DRG/APC and charge codes. The Coder HCC uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. The Coder HCC will be charged with maintaining the confidentiality of patient records and procedures. Essential Job Functions Responsible for abstracting, coding, sequencing and interpreting the clinical information from inpatient, outpatient, emergency department, pro fee and clinical medical records. Responsible for the assignment of correct principal diagnoses, secondary diagnoses and principal procedure and secondary procedure codes with attention to accurate sequencing. Utilizes technical coding principals and DRG/APC reimbursement expertise to assign appropriate codes....

A healthcare management service is seeking a Coder HCC to review medical records and perform coding for diagnoses and procedures. This full-time role requires accuracy and compliance in coding while maintaining confidentiality. Candidates must have a coding certificate and relevant experience, along with the ability to manage competing priorities. The position operates in a remote environment, offering flexibility in a supportive company culture. #J-18808-Ljbffr

It's rewarding to be on a team of people that truly believe in making an impact!We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.**Job Summary**The ACO Coding Auditor is responsible for reviewing medical records and identifying, collecting, assessing, monitoring, and documenting claims and encountering information as it pertains to Medicare Risk Adjustment. You implement ongoing quality improvement activities to assure the Medicare Risk score meets all requirements and act as a consulting MRA advisor to the practices you support. You review practices for both CMS and Commercial ACO’s for quality compliance.**Essential Duties & Responsibilities*** Performs on-site and remote clinical validation audits and interpretation of medical documentation to capture all Medicare Risk codes in coordination with the physician.* Provides guidance and consultation to practice team members to drive improved MRA coding...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information...

1 day ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health! Job Title & Role Description: The Certified Medical Coder is responsible for analyzing provider documentation to accurately select ICD-10 and CPT/HCPCS codes, ensuring compliance with coding...