436 cms hcc coder jobs found

Alignment Healthcare LLC is looking for a CMS HCC Coder for a hybrid remote position based in Orange, CA. The role requires monitoring and implementing HCC coding strategies and conducting audits to ensure data accuracy for CMS. The ideal candidate will have 3+ years of coding experience and a High School Diploma or GED. This position offers a competitive salary range of $58,531.00 - $87,797.00 and numerous opportunities for professional growth while working alongside a dedicated team focused on transforming the lives of seniors. #J-18808-Ljbffr

Hcc Coding Analyst Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This position is hybrid-remote in Orange, CA. The Hierarchical Condition Categories (HCC) Coding Analyst will effectively interface with provider partners, to successfully, monitor and implement HCC coding strategies. Audit all RAPS submissions to ensure accuracy in the data provided to Centers for Medicare and Medicaid...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This position is hybrid- remote in Orange, CA. The Hierarchical Condition Categories (HCC) Coding Analyst will effectively interface with provider partners, to successfully, monitor and implement HCC coding strategies. Audit all RAPS submissions to ensure accuracy in the data provided to Centers for Medicare and Medicaid Services (CMS). Provide...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This position is hybrid- remote in Orange, CA. The Hierarchical Condition Categories (HCC) Coding Analyst will effectively interface with provider partners, to successfully, monitor and implement HCC coding strategies. Audit all RAPS submissions to ensure accuracy in the data provided to Centers for Medicare and Medicaid Services (CMS)....

A healthcare organization is seeking a Coder to translate medical records into standardized codes and improve clinical documentation. This remote position requires an Associates degree and coding certifications. Key responsibilities include ensuring compliance with guidelines, educating providers, and safeguarding confidentiality of health information. Candidates should have expertise in CPT and ICD-10 coding and strong communication skills. A competitive pay range is offered alongside comprehensive benefits. #J-18808-Ljbffr

Company Overview Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast‑growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Job Summary Alignment Health is seeking a remote Risk Adjustment Compliance Auditor to support auditing and compliance activities related to risk adjustment data submitted to CMS. In this role, you will conduct provider and coder‑level audits, review medical record documentation and coding accuracy, identify compliance risks and...

CareFirst is looking for a Risk Adjustment Coding Specialist to support the CMS-HCC Medicare Advantage Risk Adjustment and HHS-Risk Adjustment Data Validation audit. This position requires an Associate's Degree in a related field and CCS certification upon hire. The role involves verifying diagnosis codes and maintaining coding guidelines. Candidates should have at least 3 years of relevant coding experience and be adaptable to various technology platforms. Position offers a hybrid work model, allowing some remote work. Salary ranges from $51,984 to $95,304 with a comprehensive benefits package. #J-18808-Ljbffr

Description At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD-9-CM/ICD-10-CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality assurance...

Job Summary and Responsibilities The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk‑adjusting conditions and supporting provider documentation improvement. Responsibilities Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding....

Job Description Job Summary: Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties: Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. Builds positive relationships between providers and the business by providing coding assistance...

Risk Adjustment Coding Auditor Blue Cross and Blue Shield of Minnesota is hiring a Risk Adjustment Coding Auditor. The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. An ideal candidate has 5+ years of risk adjustment coding experience and an active CRC certification. This is a production-based role requiring comfort in a high-volume environment. Your Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices Protects patient records and audit...

Coding Specialist II Fully remote position! Applicant must have the necessary equipment for the contract; 2 monitors, keyboard, mouse, web camera. If not, Agency must supply ahead of start date. The primary purpose of the Coding Specialist II is to code and verify charge data necessary to ensure correct coding, abstracting and billing on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC), observation (OBS), specialty clinics and/or inpatient OB/newborn encounters. This role is also responsible for charge review on clinic and hospital visits to ensure accurate professional charging and billing. This position requires the coder to be highly proficient in the proper assignment of ICD-10 CM, PCS, CPT, HCPCS, HCC, HEDIS CAT II, E/M and modifier codes. Demonstrates the ability to provide direction to coding staff as it relates to coding integrity, established coding guidelines and Parkland's policies to ensure accuracy of recorded patient medical information and...

Responsibilities Come and join the RMC Family! We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care. Summary Responsible for abstracting, reviewing, auditing and the education of all coding and compliance processes, as they relate to CPT, HCPCS and ICD 10 and/or HCC activity. Qualifications To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill,...

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD-9-CM/ICD-10-CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality assurance efforts....

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims...

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. We are seeking a detail-oriented and experienced Medical Coder to support Risk Adjustment and Medicare Part C audits by accurately coding inpatient, outpatient, and physician office medical records. The ideal candidate has a strong understanding of ICD-9-CM/ICD-10-CM coding guidelines and consistently demonstrates high accuracy and productivity. Responsibilities: Perform diagnosis coding of inpatient, outpatient, and physician office medical records per Risk...

Description: Join the Team at PedIM Healthcare! Delivering exceptional care, together. Who We Are PedIM Healthcare is the first private medical office of its kind in Citrus County offering top-quality care for children, adults, and seniors all under one roof. We provide pediatric, adult internal medicine, family practice, geriatrics, womens care, medical weight-loss, sleep-medicine services and more. Our dedicated, community-focused team is committed to excellence, pride in service, and making a real difference for patients and families across Citrus County. Why Work With Us? A broad, multi-discipline practice where you can grow: pediatrics, internal medicine, weight-loss & sleep medicine specialties. A values-driven environment: we listen, we help, we understandand we care. Community-oriented and recognized: voted best of the best in the region. Opportunity to make a meaningful impact by supporting patients over their full life spanfrom...

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...

Summit Medical Group is seeking a PreVisit Planning Coder to join their team. This is a f ull-time opportunity in the KNOXVILLE, TN area due to onsite requirements. Examples of Duties (List does not include all duties assigned) Medical Records review and abstractions for the assessment of HEDIS and CMS STARS quality measures and communications to improve compliance. With use of specified reports, HCC database, Athena EHR, hospital portals, member summaries and Group Management, review all records, progress notes and diagnosis for accuracy and completeness of documentation to support ICD coding to the highest level of specificity. Through record review prior to scheduled appointments, accurately identify conditions not yet incorporated in Active Problem List, gaps in preventive services and support code transitions for greater specificity and accuracy. Ensure coding and documentation criteria, rules and guidelines are met. Ensure effective, necessary tasking...

Looking for a way to make an impact and help people? PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. The Risk Adjustment Coding Auditor reviews medical records to ensure accurate, compliant ICD 10 CM coding across Medicare Advantage, ACA/Commercial, and Medicaid programs. This role validates coding accuracy and specificity, audits external coding vendors, and provides...

Allmed Staffing Inc is seeking a Certified Medical Coder for a full-time remote role. The ideal candidate will be responsible for the accurate coding of medical services across various settings. This position requires a high school diploma or GED, along with 3+ years of coding experience and active certification from AAPC or AHIMA. Strong experience in CMS HCC Risk Adjustment Models is essential, along with advanced coding knowledge. #J-18808-Ljbffr

Riverside Medical Clinic Coding Specialist Responsible for abstracting, reviewing, auditing and the education of all coding and compliance processes, as they relate to CPT, HCPCS and ICD 10 and/or HCC activity. Qualifications: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: One year minimum experience in the HCC coding field and/or CPT, HCPCS and ICD 10 experience. Proficient in excel and computer friendly. Certificates, Licenses, and Registrations: Current Medical Coding certificate specific to CRC, CPC or CCS required. Essential Functions: Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and...

Please Note: This is a hybrid position ; however, applicants must reside in California and live within a 2-hour radius of Redlands, CA to be considered. Department: UHC: Managed Care Job Summary The Coder 1 * Risk Adjustment is responsible for concurrent, prospective, and retrospective clinical documentation review as it pertains to Risk Adjustment Data Validation (RADV) timelines, with an emphasis on completeness and accuracy of provider documentation related to severity of illness and supporting clinical care plan(s) for the validation of Hierarchical Condition Category (HCC) diagnoses. Initiates communication, verbal and written, with providers to facilitate clarification of need for greater specificity, clinical support, and/or completeness of the progress notes. Provides compliant education related to documentation integrity, completeness, and consistency. Keeps providers up to date on CMS, ICD-10-CM, AHA Coding, health plan etc. guidelines as it pertains to Risk...