Coder 1 risk adjustment jobs | Healthcare Careers

Loma Linda University Health Redlands, CA

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...

LL

Coder 1-Risk Adjustment

Loma Linda University Medical Center Redlands, CA

Job Description 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...

Co

Coder 1/HCC Risk Adjustment

Cotiviti United States

Remote Risk Adjustment / Hcc Coder (Coder 1) The Coder I is responsible for conducting accurate, compliant, and complete diagnosis code abstraction for Medicare, Commercial, and Medicaid risk-adjustment programs across a variety of chart types. This role applies ICD-10-CM Official Guidelines, AHA Coding Clinic guidance, and Cotiviti/client-specific requirements to ensure high-quality coding outcomes. The Coder I utilizes established dispute-resolution processes when coding disagreements arise and communicates professionally with team leadership regarding findings, errors, and improvement opportunities. We are currently looking for multiple Remote Risk Adjustment / Hcc Coders (Coder 1) for full-time permanent positions. Responsibilities Reviews medical records for accurate, compliant, and complete diagnosis code abstraction from a variety of chart and encounter types to support Medicare, Commercial and Medicaid prospective, concurrent and retrospective risk adjustment...

Seasonal/Temporary

HCC Coding Specialist (Temporary, FT and PT available)

Virtix Health Remote

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. Risk Adjustment Coding Specialists are an important part of the Team at Virtix Health. The HCC Coding Team Member will review medical records to abstract ICD-10 codes, specifically those that map to HCCs, RxHCCs, and ESRD models. Coders will follow Medicare guidelines, ICD-10-CM guidelines as well as client specific requirements. Equipment provided along with Encoder software with access to AHA Coding Clinic This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES:...

Full Time

Medical Coding and Billing Analyst

C2Q Health Solutions Hybrid (NY)

JOB PURPOSE: Responsible for supervising, evaluating, and consistently improving the day-to-day operations of Medical Practice. This role is responsible for accurate and timely billing of insurance claims and patient statements across multiple sites, implements accurate medical coding policies, and enhances operational processes. It involves acting as a liaison between coding operations and clinical staff, training and coaching medical personnel on coding guidelines, and ensuring the accuracy and timeliness of clinical documentation. Additionally, the role includes analyzing and optimizing diagnosis data submission processes, presenting performance results to leadership, and supporting HCC/RAF optimization strategies. The role will also oversee the training of Medical Practice Assistants, Physician and IDT disciplines in ICD-9/ICD-10 guidelines. JOB RESPONSIBILITIES: Responsible to deliver accurate and timely billing of insurance claims and patient statements for all...

KH

Risk Adjustment Coder — Elevate HCC & CPT/ICD-10 in EPIC

Kettering Health Network Kettering, OH

Kettering Health Network is seeking a full-time Risk Adjustment Coder for their office in Kettering, OH. This role focuses on coding compliance and ensures adherence to CMS billing rules while supporting clinical outcomes through documentation feedback to providers. The ideal candidate will have a High School Diploma, relevant coding certifications, and prior experience in professional fee coding. This position fosters relationships with healthcare providers and contributes to improving coding practices. #J-18808-Ljbffr

Bi

Registered Nurse - Utilization Management/Coder RN

Bienvivir El Paso, TX

Registered Nurse - Utilization Management/Coder RN Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Bienvivir is currently accepting applications for the following position: REGISTERED NURSE - UTILIZATION MANAGEMENT / CODER The...

UH

Medical Coding Specialist II - Radiology

UW Health Middleton, WI

Work Schedule: This is a full-time, 1.0 FTE position that is 100% remote. Hours may vary based on the operational needs of the department. Applicants hired into this position can work from most states. This will be discussed during the interview process. To be eligible to work remotely, you must be in an approved remote work state for UW Health. We've included a link below to view the full list of approved remote work states. Approved Remote Work States Listing Be part of something remarkable Join the #1 hospital in Wisconsin! We are seeking a Medical Coding Specialist II to Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD)...

Cf

Inpatient Coder

Center for Health Care Strategies Birmingham, AL

Job Description: Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties. Meets minimum requirements for production and quality monthly. Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component. Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses. Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs. Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered. Requires excellent coding knowledge of...

RR

Coder-Outpatient

Rochester Regional Health Rochester, NY

SUMMARY Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and/or CPT codes for billing, internal and external reporting, research, and regulatory compliance. Under the direction of the HIM Coding Manager, accurately codes conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting and/or CPT Assistant. Demonstrates knowledge of reimbursement methodologies and applies to assigned charts in order to optimize reimbursement and/ or resolve regulatory edits. Resolve error reports associated with billing process, identify and report error patterns, and, when necessary, assist in design and implementation of workflow changes to reduce billing errors. STATUS: Full-time LOCATION: Remote SCHEDULE: Day shift RESPONSIBILITIES • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines and...

TE

HCC Auditor/Coder — Risk Adjustment & Coding Expert

TEKsystems California, MO

TEKsystems is looking for an HCC Auditor/Coder in California to improve provider documentation and reporting of chronic health conditions. In this role, you will conduct audits, ensure accurate coding according to guidelines, and collaborate with providers. The ideal candidate should have a high school diploma, coding certification, and familiarity with various coding methodologies. This is a fully onsite position in Los Angeles, CA 91325, offering a range of benefits including medical, dental, vision, and a 401(k) plan. #J-18808-Ljbffr

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HCC Coder

TEKsystems California, MO

HCC Auditor / Coder – Job Description The HCC Auditor/Coder is responsible for improving the accuracy and quality of provider documentation and reporting of chronic health conditions. This role supports risk adjustment initiatives through medical record audits, coding review, provider education, and ongoing collaboration with internal teams and provider offices. The HCC Auditor/Coder reviews medical records and super bills to ensure appropriate assignment of diagnosis and procedure codes in accordance with HCC, ICD‑10, CPT, and HCPCS guidelines. This position works as an integral member of the Finance Department and consistently meets established productivity and quality standards. Key Responsibilities Audit provider medical records and super bills for accurate and compliant diagnosis and procedure coding Review a wide variety of document types, including primary and specialty care, inpatient, outpatient, mental health, substance abuse, ancillary, laboratory, and pharmaceutical...

CH

Risk Adjustment Coder IHCI

Community Health Network Indianapolis, IN

Remote / Work from Home / Virtual / Hybrid Location Shadeland Station, Shadeland Ave, Indianapolis, IN 46256, United States Responsibilities Timely, accurate, and complete review of patient charts following patient encounters, utilizing a variety of technical platforms to complete workflows. Validating diagnosis codes representing patient conditions along with necessary MEAT documentation. Ensuring coding is consistent with guidelines from regulatory entities. Conducting audits to meet compliance with ACA standards. Creating post‑visit queries with follow up. Collaborating with CDI team members, particularly with clinical findings. Contributing to the provider education body of work, participating in pre‑encounter reviews as needed. Qualifications Applicants for this position should be able to collaborate with others in a team setting, have excellent communication skills, and a positive attitude toward problem‑solving. Critical thinkers. High School diploma or GED is...

CH

Remote Risk Adjustment Coder | HCC & Compliance Expert

Community Health Network Indianapolis, IN

Community Health Network is looking for a remote coding professional in Indianapolis, IN. The role requires an excellent communicator with a high school diploma or GED, and preferably an associate degree. Candidates should have at least three years of professional outpatient Risk Adjustment coding experience and the ability to validate diagnosis codes. Additionally, certification from AAPC or AHIMA within six months is necessary. The position permits remote work but requires residency in specific states. #J-18808-Ljbffr

CI

Specialty Physician Coder

Careers Integrated Resources Inc Fountain Valley, CA

Job Title: Specialty Physician Coder Job Location: Fountain Valley, CA Job Duration: 3 Months (possibility of extension) Payrate: $45.00 - $48.27/ hr. on w2 Job Summary: Under the direction of the Coding Compliance Manager, the Specialty Physician Coder plays a key role in reviewing and analyzing specialty coding and billing for charge processing. This role is responsible for reviewing and accurately coding office, hospital, and surgical/procedures for reimbursement, ensuring accurate and compliant medical coding for inpatient and outpatient services, diagnostic tests, and other medical services rendered to patients. The Specialty Physician Coder will also collaborate with the Coding Compliance Manager to identify coding trends, irregularities, and required action items. Essential Functions and Responsibilities: Meet productivity standards established by management Meet quality standards established by management In adherence with standard work, analyze and...

UH

Remote Certified Medical Coder

Upward Health FL

Company Overview :Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application.Upward Health is an in-home, multidisciplinary medical group providing 24 / 7 whole-person care.Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help.Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients.We are able to treat a wide range of needs - everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals - because we know that health requires care for the whole person.It's no wonder 98% of patients report being fully satisfied with Upward Health!Job Title & Role Description :The Certified Medical Coder is responsible for analyzing provider documentation to accurately select ICD-10 and CPT / HCPCS...

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Risk Coder

Community Care Cooperative Boston, MA

Title: Certified Risk Coder Reports to: Manager, Risk Coding Classification: Individual Contributor Location: Boston (Remote) Job description revision number and date: 2.0, 01.06.2025 Organization Summary: Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. Job Summary: The Certified Risk Coder will be a part of an emerging coding team and coding service that...

IC

Senior Medical Coder

ICON Consultants, LP Phoenix, AZ

Job Summary ICON Consultants, on behalf of a client, is looking for someone who is directly responsible and accountable for performing chart reviews, physician education, and maintaining comprehensive knowledge of coding rules and regulations. Provide overall coding expertise as well as administrative and technical oversight to ensure successful integration of the company initiatives. Responsibilities Performs on-going chart reviews and abstracts diagnosis codes Coordinate with Clinical Informatics on system errors and suggest improvements to ensure effective and efficient processes are followed Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly Documents results/findings from chart reviews and provides feedback to management, providers, and office staff Creates necessary tools (educational materials, newsletters, etc.) for providers to assist them in current and accurate coding...

RM

Certified Medical Coder – ICD-10, CPT & HCC Specialist

Riverside Medical Clinic Riverside, CA

Riverside Medical Clinic in Riverside, CA is seeking a coding specialist responsible for auditing and reviewing coding compliance processes related to CPT, HCPCS, and ICD 10. Candidates must possess a current Medical Coding certificate and a minimum of one year experience in HCC coding. This role offers a challenging work environment with growth opportunities within the organization. Riverside Medical Clinic values quality healthcare and aims to transform the delivery of medical services in the community. #J-18808-Ljbffr

TJ

Medical Coder

The Judge Group New York, NY

About the Role Type: Contract Duration: Contract through end of January (possibility of extension) Schedule: 40 hours per week (part‑time option available at 20 hours, must follow training schedule) Rate: $27/hr Start Date: ASAP We are seeking experienced Medical Coding Specialists to join on a short‑term contract through the end of January. This role is fully remote and requires a commitment to a two‑week training period before beginning production work. Candidates must be credentialed through AAPC or AHIMA (CPC‑A applicants will not be considered). Responsibilities Complete assigned medical coding tasks accurately and efficiently Participate in required two‑week training program Follow established coding guidelines and compliance standards Meet productivity and quality expectations Participate in assessment setup prior to start Qualifications Required Active certification through AAPC or AHIMA Risk Adjustment or HCC Experience Strong knowledge of medical...

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HCC Risk Adjustment Coder II — Educator & Analyst

St Luke's Health Houston, TX

St Luke's Health is looking for a Value Based Coder II in Houston, Texas. This role involves reviewing patient medical records to enhance coding opportunities with a strong emphasis on Hierarchical Condition Categories (HCC). The ideal candidate will have 2+ years in outpatient coding and a deep understanding of risk adjustment principles. Responsibilities include providing education to network providers and ensuring compliance with coding guidelines. #J-18808-Ljbffr

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HCC Risk Adjustment Coder II - Education & Compliance

CommonSpirit Health Houston, TX

CommonSpirit Health is seeking a Value Based Coder II in Houston, Texas. This role involves reviewing patient medical records to identify coding opportunities with a focus on Hierarchical Condition Categories (HCC). You will develop provider education and actively support process improvement initiatives. The ideal candidate will have at least 2 years of outpatient coding experience, advanced knowledge of coding guidelines, and the ability to communicate effectively with providers. Join us in enhancing healthcare quality through precise coding and compliance. #J-18808-Ljbffr

BC

Quality Assurance Coder/Auditor - Hybrid

Blue Cross Blue Shield of Arizona Phoenix, AZ

Quality Assurance Coder/Auditor 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...

NE

HEALTH CODER - HCC & RISK ADJUSTMENT

North East Medical Services Burlingame, CA

Health Coder - Hcc & Risk Adjustment Burlingame, CA 94010 Overview Salary Range $42.79 - $48.75 Hourly Description The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization's quality outcomes and financial performance. Essential Job Functions: Hcc Coding and Risk Adjustment (Ra) Program Support Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with Hcc and risk adjustment guidelines. Ensure all...

251 coder 1 risk adjustment jobs found