106 senior coder risk adjustment jobs found

Responsibilities Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent...

Prominence Health, a value-based care organization, seeks a Senior Coder to review medical records and ensure accurate coding for diagnosis and service codes across partner practices. The role involves pre, post, and wraparound visit input and may require occasional onsite work and travel for provider education. The ideal candidate has CMS coding knowledge, 2+ years in Risk Adjustment Coding, and CRC/AAPC credentials, with bilingual Spanish preferred and experience navigating EMR systems. #J-18808-Ljbffr

Prominence Health is seeking a Senior Coder to perform documentation and coding reviews for services rendered across partnered practices. You will ensure accurate diagnoses and service codes to support risk adjustment and quality measurement, with pre, post, and wraparound input. Some onsite work and occasional travel may be involved. Strong CMS coding knowledge, HCC experience, and EMR proficiency are essential. Bilingual Spanish is a plus, and CRC/AHIMA credentials are preferred. #J-18808-Ljbffr

Prominence Health is seeking a Senior Coder to review medical records and ensure accurate reporting of diagnoses and codes across partner practices. This role supports risk adjustment and quality measurement with pre, post, and wraparound input. Occasional onsite work at provider offices is required, with travel to out-of-state trainings. Strong CMS/HCC coding knowledge and bilingual capability (Spanish preferred) enhance success in this role. #J-18808-Ljbffr

Mount Sinai Medical Center is seeking an experienced billing/coding professional to ensure accurate documentation and risk adjustment coding across patient records. The role emphasizes knowledge of CMS guidelines, ICD-10-CM and CPT, and maintaining active credentials with ongoing education. Responsibilities include chart reviews within 24-48 hours, providing physician education on documentation gaps, and interpreting CSI reports to prioritize timely, accurate coding across departments. #J-18808-Ljbffr

Direct Jobs is seeking a Risk Adjustment Coder II in Houston, Texas. This role involves advanced support for medical record reviews, ensuring correct capture of chronic conditions and compliance with CMS guidelines. The Coder II acts as a subject matter expert, facilitating team training and audits. The ideal candidate will have a Bachelor's degree or equivalent experience in risk adjustment, along with relevant coding certifications. Experience in Commercial and Medicare coding is required alongside strong analytical and communication skills. #J-18808-Ljbffr

Community Health Choice, Inc. seeks a Risk Adjustment Coder II in Houston, Texas. The role involves advanced medical record reviews and coding of chronic conditions to ensure correct risk scoring, complying with CMS guidelines and internal policies. The ideal candidate has a Bachelor's degree or equivalent experience, and AHIMA/AAPC certification, along with 3-5 years of experience in risk adjustment coding. Join a team dedicated to improving healthcare quality for over 400,000 members. #J-18808-Ljbffr

Universal Health Services is seeking a Senior Coder to handle the documentation and coding review for medical records across partnered practices. Candidates must have a deep understanding of CMS coding and at least 3 years of experience in this field. The role requires both remote work and occasional onsite visits. This position offers a rewarding and challenging work environment along with competitive benefits, including a Loan Forgiveness Program and excellent medical plans. #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

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, Inc. is looking for a Risk Adjustment Coding Specialist II to support high-volume coding efforts in Orange County. This full-time position offers opportunities to analyze data and educate providers, requiring travel up to 75% of the time. The ideal candidate should have significant experience in risk adjustment coding, critical presentation skills, and a valid driver's license. Compensation ranges from $70,000 to $85,000 per year, depending on experience and location. #J-18808-Ljbffr

A consulting firm specializing in health care disputes seeks a Sr. Associate to utilize their expertise in coding, revenue cycle, and clinical operations. Responsibilities include coding diagnoses from medical records and managing small projects while ensuring compliance with regulations. Candidates should be certified in Risk Adjustment Coding (CRC) with strong analytical and communication skills. There is a competitive salary range of $85,000 to $200,000 and opportunities for hybrid work arrangements. #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 largest...

A consulting company is searching for a Sr. Associate with expertise in coding, revenue cycle, and clinical operations. This role focuses on complex investigations, compliance evaluation, and project management within healthcare disputes. The ideal candidate must be CRC certified with a strong grasp of clinical terminology and health regulations. Excellent communication skills and proficiency in Excel, Word, and PowerPoint are essential. The position offers a salary range from $85,000 to $200,000, depending on experience and location. #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 largest...

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to support our physician practices remotely. You will perform high-volume chart reviews to identify coding gaps and improve accuracy, translating findings into education for providers and practice leaders while tracking KPIs such as HCC recapture and AWVs. The ideal candidate has 3–5 years of risk adjustment experience, CPC/CRC credentials, and strong communication skills to educate and collaborate with provider teams. #J-18808-Ljbffr

Join Our Caring Community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities: Deliver coding and documentation education to providers and clinic staff within IPA clinics. Be a consultative resource and ongoing support for providers in assigned clinics. Conduct documentation audits to identify gaps, trends, and opportunities for improvement. Perform quarterly chart reviews to support coding accuracy...

Porter is hiring a Risk Adjustment Coder to join our Team! Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter's Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member's specific needs, and directs Porter's team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience. Position Overview We are seeking a certified coder with expertise in risk adjustment coding and a specialization in in-home health...

Medical Coding Professional 2 The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, you will be assigned a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify STARS gaps and...

Become a part of our caring community Become a part of our caring community and help us put health first The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating...

Join Our Caring Community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities Deliver coding and documentation education to providers and clinic staff within IPA clinics. Be a consultative resource and ongoing support for providers in assigned clinics. Conduct documentation audits to identify gaps, trends, and opportunities for improvement. Perform quarterly chart reviews to support coding accuracy...

Become a part of our caring community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities deliver coding and documentation education to providers and clinic staff within IPA clinics. be a consultative resource and ongoing support for providers in assigned clinics. conduct documentation audits to identify gaps, trends, and opportunities for improvement. perform quarterly chart reviews to support...

Medical Coding Professional 2 The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify STARS gaps and deficiencies....

Senior Professional Coder The Senior Professional Coder will apply an advanced professional coding skill set to act as a service line coding team lead expert, working collaboratively to support all workflows related to professional fee coding/charging/denials follow-up. Coordinates with others as needed to ensure comprehensive and timely completion of professional coding processes. Audit CPT and ICD-10 diagnosis coding applied by providers and coding staff to assure compliance with federal and state regulations and insurance carrier guidelines. Provide education, instruction and training to providers and coding staff. Act as an expert for the HCC/Risk adjustment coding. This position is remote but does require onsite education to providers as needed. Essential Duties and Responsibilities Review, analyze, and validate CPT and ICD-10 diagnosis codes and charges applied by providers to assure compliance with federal and state regulations and insurance carrier guidelines. Ensuring...