105 risk adjustment coder specialist jobs found

Risk Adjustment Coder Specialist 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 ourselvesone 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 completed from your home office, occasional travel may be required for...

Risk Adjustment Coder Specialist 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 ourselvesone 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 completed from your home office, occasional travel may be required...

Risk Adjustment Coder Specialist 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 ourselvesone 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 completed from your home office, occasional travel may be required for...

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...

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...

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...

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...

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 completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency The base pay for this role is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities Responsible for daily operations pertaining to Risk...

Medical Coder - Risk Adjustment Specialist Join Senior CommUnity Care as a Medical Coder - Risk Adjustment Specialist and partner directly with physicians and Medical Directors to improve documentation, support CMS reporting, and strengthen value-based care for older adults in the PACE program. Medical Coder - Risk Adjustment Specialist- Remote Schedule: M-F 8:00 AM-5:00 PM Salary: $58,000-$66,000 (Based on Experience) Essentials: Collaboration for Risk Adjustment Integrity: Works closely with Medical Directors and PACE providers to uphold the integrity and accuracy of the risk adjustment reporting process. Engages in continuous dialogue with healthcare professionals to ensure that coding accurately reflects participant acuity. Medication Documentation Review and Diagnostic Coding: Reviews and interprets provider documentation to extract critical information. Assigns ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures from documented information in the medical record....

A healthcare provider organization is seeking a Risk Adjustment Coding & Documentation Specialist to oversee compliance activities related to Medicare and Medicaid. This role includes conducting medical record reviews, supporting risk adjustment data validations, and ensuring proper coding standards are met. Candidates should possess an Associate's degree and relevant coding certifications, along with medical coding experience. The position offers benefits like medical plans, 401k matching, and tuition assistance, within a hybrid work model. #J-18808-Ljbffr

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,...

A regional health insurance provider seeks a Coder to manage chart abstraction and vendor auditing to comply with regulations. You’ll need 5 years of coding experience, including 3 in Risk Adjustment coding, along with a CPC Certification. This full-time remote position requires strong organizational skills and proficiency in essential computer software. Join a growing organization committed to providing quality health plans while enjoying competitive salaries and excellent benefits. #J-18808-Ljbffr

Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual, family, and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5‑Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Position Summary Performs chart retrieval, medical record review, HCC identification and data quality oversight for risk mitigation and revenue recovery for both Medicare and ACA services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for coding questions/issues. Determines...

A leading health organization seeks a skilled candidate for HCC coding roles in Boyce Lawn, South Carolina. You will lead prospective and retrospective reviews to identify and confirm coding opportunities with providers. The role requires five years of professional coding experience along with CPC and CRC certifications. The ideal candidate will excel in communication and proficiency in healthcare coding software. Join us to inspire health and serve with compassion. #J-18808-Ljbffr

A healthcare company in Houston is seeking a Certified Medical Coder to review and code inpatient and outpatient medical records. You will ensure compliance with ICD-10-CM and HCPCS guidelines while meeting productivity standards. Candidates need a high school diploma, relevant certifications, and at least three years of experience in risk adjustment. AAPC or AHIMA credential is required. The role also values attention to detail and knowledge in managed care. #J-18808-Ljbffr

Inspire Health. Serve With Compassion. Be The Difference. Codes medical information into the Prisma billing/abstracting systems using established professional and regulatory coding guidelines. Ensures that each diagnosis present on admission (POA) indicator is assigned appropriately. Codes for multiple facilities. Adheres to Prisma Health Coding and Compliance policies and procedures for assignment of complete, accurate, timely and consistent codes. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Codes medical information into the Prisma billing/abstracting systems using established professional and regulatory coding guidelines. Performs Inpatient coding including major traumas and Neonatal Intensive Care Unit (NICU) records by assigning International Classification of Diseases (ICD) and International Classification of Diseases-Procedure Coding System...

A leading health care company is hiring a Coding Specialist to enhance health care delivery through coding compliance. You will work remotely, identifying and monitoring coding information essential for Medicare Risk Adjustment and educating providers. The role requires strong analytical skills and a commitment to customer service. Required qualifications include a High School Diploma, coding certifications, and at least one year of relevant experience. Competitive compensation and comprehensive benefits are offered. #J-18808-Ljbffr

Coder II - ProFee Trauma 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. Includes inpatient E/M coding and clinic E/M coding as well as trauma surgery...

Coder I - Lee Pain Management 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 and HCC codes. Facility Specific: Responsible for coding ED, Diagnostic, and Ancillary records. Professional Fee: Responsible for Diagnostic, HCC, Retrospective Coding, Documentation Quality Assurance, and Ancillary Records. Educational Requirements High School Diploma or Equivalent Required Experience Requirements 1 Year Outpatient Coding Preferred Additional Requirements 1 Year of Outpatient (Acute Care Hospital or Physician) Coding or...

A leading health care organization is seeking a dedicated Coding Specialist to work remotely. The role involves identifying and documenting claim coding information while supporting governmental compliance. Candidates must have a High School diploma, coding education, and specific certifications. Strong analytical skills and problem-solving abilities are essential. This position offers competitive compensation and focuses on enhancing community health. Join a team striving for innovation and excellence in health care delivery. #J-18808-Ljbffr

A growing healthcare organization is seeking a Risk Adjustment Coding Specialist to ensure accurate and complete diagnosis documentation for value-based care. The ideal candidate should have experience in HCC and CPT coding, alongside strong interpersonal skills. This role is primarily remote but needs occasional on-site meetings. The organization offers comprehensive benefits including medical, dental, and generous PTO, amongst others. #J-18808-Ljbffr

Hcc Coding Quality Educator Location: Madisonville, Louisiana, United States of America Category: Clerical Remote: Office/Remote Hybrid Widget: Full time Undefined: Regular At St. Tammany Health System, delivering world-class healthcare close to home is our goal. That means we are committed to attracting and retaining the very best professionals for every position in our health system. We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nestled in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste. Job Description and Position Requirements Scheduled Weekly Hours: 40 Job Summary: The HCC Coding Quality Educator (HC) facilitates the improved integrity of medical record documentation through interaction with healthcare providers to support the appropriate representation of severity of illness,...

Pace Medical Coder The PACE Medical Coder will review clinical documentation and diagnostic results as necessary to verify the appropriate assignment of the ICD-10 CM, CPT and HCPCS codes as per Official Guidelines for Coding and Reporting. This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum monthly on-site requirement; additional on-site presence may be required based on business need. Essential Functions of the Job: Reviews the Chart Progress Notes, patient documentation for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers. Determines all HCC codes associated with patient encounters. Keeps up to date with the latest CMS risk adjustment guidelines. Verifies all diagnostic procedural codes from the electronic health record using ICD-10 CPT and HCPCS coding classifications. Communicates effectively with providers concerning documentation to...

Description Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk-based audits, support external audit coordination, and ensure alignment with CMS and DMHC regulations across the organization. Reporting to the Compliance Manager, MAPD Audit, you will contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide regulatory readiness and operational improvement. This position calls for a strong foundation in CMS guidelines, managed care compliance, and effective collaboration with both internal teams and external partners. In this role, you will: Conduct compliance audits related to operational functions, vendor performance, data validation, RADV, Triennial Review, pre-delegation reviews, and...