15 senior coder risk adjustment jobs found

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

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 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

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...

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...

Senior Risk Adjustment Coder The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. What you will do: Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses. Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes. Inquire with clinicians the recommended HCC diagnosis for chart addendum. Collaborating with other departments to address coding updates and support risk adjustment...

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...

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 Analyze data from contracted IPA network providers that allows for proper review of data to evaluate HEDIS and Risk...

Location: Long Beach, CA/Surrounding areas (Remote, must be withing 50 miles of Long Beach or Woodland Hills, CA incase of any onsite needs) Hours: 8-5 PST Start Date: ASAP Client Overview A leading nonprofit health plan serving millions of members across commercial, Medicare, Medicaid, and individual market programs. The organization is committed to improving healthcare quality, affordability, and access through innovative care delivery models, population health initiatives, and regulatory compliance excellence. This role supports enterprise-wide risk adjustment, medical record review, and government audit activities that help ensure accurate documentation, coding integrity, and compliance with federal and state requirements. Job Description Seeking two experienced Senior Medical Review Coders to support high-priority government audit and medical record review initiatives. Responsibilities include retrospective and prospective medical record reviews, coding validation,...

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are 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. Who Are We? 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 Summary The Risk Adjustment Coding Auditor is responsible for conducting...

Job Details Location: Huntington Beach Office, Huntington Beach, CA 92647. Position Type: Full Time. Salary Range: $72,800.00 – $80,000.00. This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting retrospective and prospective coding audits, diagnosis validation reviews, provider documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record documentation and ICD-10-CM diagnosis coding to ensure compliance with CMS Risk Adjustment program requirements, Official Coding Guidelines, AHA Coding Clinic guidance, and organizational policies. Functions & Responsibilities Conduct retrospective, prospective, and targeted coding audits to assess the accuracy, completeness, and compliance of ICD-10-CM diagnosis coding and HCC capture....

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are 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. Who Are We? 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 Summary The Risk Adjustment Coding Auditor is responsible for...

Job Description Job Description Coder Router is responsible for effective and efficient completion of departmental tasks and ensuring those tasks are performed on time with high quality and attention to detail. Role may be updated in the future; task items may be removed or added verbally or in writing as the needs of the company evolve. CODER/ROUTER: • Direct Costs: Receive invoices from Stampli and code to correct project and activity code in NetSuite. Research the PO number in ComputerEase and add the corresponding PO number, job, phase, and category into Stampli. • Indirect & SG&A Costs: Receive invoices from Stampli and code to correct general ledger accounts in NetSuite. • Route Invoices: Route invoices for approval to appropriate parties. ACCOUNTS PAYABLE (BACKUP): • AP Import: Import accounts payable invoices and Ramp reimbursements from NetSuite into ComputerEase. • Vendor Account Reconciliations: Reconcile vendor statements against accounts. • Mailed...

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...