265 coder 1 risk adjustment jobs found

Overview Cotiviti drives better healthcare outcomes through data analytics. Our payment accuracy, revenue integrity, risk assessment and stratification, and quality improvement solutions help organizations utilize their data so they can efficiently and cost-effectively succeed in the new era of healthcare. We are currently looking for multiple Remote Risk Adjustment / HCC Coders (Coder 1) for full-time permanent positions. See what it's like to work as a Coder at Cotiviti: https://www.youtube.com/watch?v=-VgcV09cxCo Responsibilities Ability to review medical records for accurate, compliant, and complete diagnosis code abstraction for Medicare, Commercial and Medicaid risk adjustment from various chart types (physician, facility, and non-facility). May have special projects that will entail a full coding review. Ability to code following the ICD-10-CM Official Guidelines for Coding and Reporting, AHA’s Coding Clinic and well as Cotiviti and client specific coding guidelines....

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Risk Adjustment Coder, to join in leading the organization forward. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. Learn more about McLaren Health Plan at...

Job Description Job Description 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...

Salary Range $21.47 - $34.31 Overview Located in the heart of Washington, we enjoy open skies, snow-capped mountains, and the lakes and rivers of the high desert. We are the proud home of orchards, farms, and small communities. Confluence Health actively supports the communities we serve and their quality of life through our community support program and through our individual efforts as involved community members. Employees of Confluence Health receive a wide range of benefits in addition to compensation. Medical, Dental & Vision Insurance Flexible Spending Accounts & Health Saving Accounts CH Wellness Program Paid Time Off Generous Retirement Plans Life Insurance Long-Term Disability Gym Membership Discount Tuition Reimbursement Employee Assistance Program Adoption Assistance Shift Differential For more information on our Benefits & Perks, click here! Summary Up to $500 in Bonuses! $250 Sign On Bonus and $250 Retention...

Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure The Coding Auditor, Senior performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. Specific approaches to job duties vary depending on the department. Estimated Hiring Range $81,000.00 - $99,000.00 Bonus Target Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. Essential Responsibilities Perform and lead a variety of coding-related audits for providers and other entities. Review medical records to verify that complete and accurate...

Summary The HCC Coding Auditor will perform code audits and abstractions using the Official Coding Guidelines for ICD-10-CM and AHA Coding Clinic Guidance, following all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor will be involved with quality assurance auditing and risk adjustment code abstraction for the following programs: Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is a hybrid role. Responsibilities Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Performs Medical Record reviews and audits based on organizational priorities. These can include prospective and concurrent Clinical Documentation Improvement (CDI) workflows and retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk...

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 Description: Come and join our growing organization as a Medical Coder - Certified ! Roswell Park Care Network is a recognized leader in oncology and specialty care, supporting community physician practices across New York State. We are committed to delivering exceptional patient care while advancing innovative treatment options in a collaborative and patient-focused environment. Comprehensive Benefits: Monday-Friday schedule Medical, dental, and vision coverage Employer funded Health Reimbursement Account (HRA) 401(k) with company match Generous vacation and sick time Company-paid life insurance 11 paid Holidays The Medical Coder position offers a hybrid schedule. After successfully completing on-site training, the schedule transitions to just one on-site day per week As the Medical Coder you are responsible for reviewing medical records to assure proper billing of the medical service, comparison of physician...

Peak Performers has partnered with a healthcare organization to assist in their search for a remote Sr. Risk Adjustment Coder. In this position, you will be responsible for reviewing and analyzing medical records, validating diagnosis codes, and supporting risk adjustment audit activities to ensure accurate reporting to government programs. Major Duties Review and code inpatient and outpatient medical records using ICD-10 guidelines for risk adjustment purposes. Analyze and validate diagnosis coding to ensure accuracy and compliance with CMS risk adjustment and HCC guidelines. Support Risk Adjustment Data Validation (RADV) audits by reviewing historical audits and assisting with third-pass coding reviews. Assist with quality assurance of documentation packages prior to submission to government agencies. Identify trends in coding data and contribute to reporting efforts such as HCC trend tracking and audit analysis. What are we looking for? Associate’s or Bachelor’s degree...

A prominent healthcare institution is seeking an entry-level Health Information Coder I. This fully remote role involves coding various healthcare settings using ICD-10-CM, CPT, and HCPCS classification systems. The ideal candidate will ensure coding accuracy and compliance with UCSF policies while working with healthcare providers and revenue cycle teams. Emphasis on productivity, quality benchmarks, and maintaining high standards is essential. Qualifications include a high school diploma and CRC certification, with preferred experience in coding. #J-18808-Ljbffr

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...

A healthcare staffing agency is seeking a Sr. Risk Adjustment Coder to work remotely. In this role, you will review medical records and validate diagnosis codes to support government programs. The ideal candidate should have over 5 years of risk adjustment coding experience and relevant certifications. This position offers a contract at $31.34/hour with possible extensions. Benefits include medical insurance and a retirement plan. #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,...

A healthcare organization is seeking a Certified Risk Coder in Boston. This role involves retrospective and prospective risk coding reviews, ensuring accurate documentation and risk adjustment for outpatient practices. The ideal candidate will have experience in risk adjustment and medical billing, proficient knowledge in EHR systems, and a CRC Certification. Join a fast-paced, innovative team requiring strong communication and customer service skills with an emphasis on quality assurance. #J-18808-Ljbffr

Title - Coding Auditor Location - Clackamas, OR Job Type - Permanent Job Summary: To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP),...

Candidates must reside either in Washintgon or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid...

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 & Coder, Risk, Specialist, Healthcare, Medical

A non-profit managed care organization in Texas is seeking a Risk Adjustment Coder II to conduct complex medical record reviews and code chronic conditions accurately. This role requires 3-5 years of experience in risk adjustment coding and relevant certifications. The ideal candidate will ensure compliance with coding guidelines and contribute to departmental goals. Strong analytical and interpersonal skills are essential, along with proficiency in Microsoft 365. This position supports high-quality healthcare access for members. #J-18808-Ljbffr

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...

A healthcare organization in Houston seeks an experienced Value Based Coder II to conduct thorough reviews of patient medical records, focusing on Hierarchical Condition Categories (HCC). The role involves delivering provider education, participating in compliance monitoring, and contributing to performance improvement initiatives. Candidates should have a relevant bachelor's degree or equivalent experience, along with coding certifications. Strong knowledge of CPT and ICD-10 coding, risk adjustment models, and excellent communication skills are essential. #J-18808-Ljbffr

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions. Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription...

Job Description Job Description Lamoille Health Partners is looking for a Certified Medical Coder to accurately translate diagnostic and procedural information from patient medical records into standardized codes. The Medical Coder plays a crucial role in ensuring accurate billing and reimbursement, as well as contributing to valuable healthcare data collection. ESSENTIAL FUNCTIONS: Review and analyze patient medical records, including physician notes, operative reports, laboratory and radiology results, and discharge summaries, to identify pertinent diagnoses and procedures. Accurately assign ICD-10-CM, CPT, and HCPCS codes according to official coding guidelines and regulations. Ensure proper sequencing of codes to optimize reimbursement and meet payer requirements. Abstract relevant information from medical records, including patient demographics, diagnoses, procedures, and dates of service. Identify and resolve coding discrepancies, errors, and omissions by...

Coding Auditor/ Educator, Physician Billing HMH PHYSICIAN SERVICES, INC. Edison, New Jersey Apply Requisition # 2026-175977 Shift: Day Status: Full Time with Benefits Overview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Physician Billing (PB) Coding Auditor and Educator is responsible for auditing and educating healthcare providers on related applicable clinical documentation. This work supports coding and billing regulations that ensure appropriate reimbursement, public reporting, and various initiatives as...