229 coder 1 risk adjustment jobs found

Job Description Department: UHC: Managed Care-LLUHC/41077 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 Adjustment for the purpose of, documentation trends and opportunities for improvement related to documentation integrity....

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 coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance. Conduct...

Job Summary The Coder's primary job function is to certify accurate billing for professional services and hospital procedures. This is accomplished through review of clinical encounters, confirming correct use of diagnosis and procedural codes and application of appropriate modifiers and CCI edits. The Coder provides education to providers to ensure proper completion of the medical record. Job Specific Competencies 1. Reviews clinical encounters presented via electronic lists to ensure proper submission of services prior to billing. a. Edits and corrects diagnosis and procedural codes and applies modifiers and CCI edits as required according to coding guidelines and department policy. b. Effectively utilizes coding software and/or books to confirm coding accuracy. c. Verifies referring provider, rendering provider, department and other critical data elements are accurate prior to submission of completed coding. 2. Receives and reviews paper fee slips for hospital...

Job Description Job Description At ElevaIT, we’re currently looking for a Senior Specialty Physician Coder for a 3+ Months Contract with our direct client. Job Title: Senior Specialty Physician Coder Location: Remote Duration: 3+ Months (Possibility of conversion into FT) Top Skills Surgical breast oncology (including plastic reconstructive breast surgery), Hematology/Oncology OR Cardiology and cardiac surgery experience Must be able to abstract the chart review to capture all billable charges Strong chemotherapy and infusion experience CHONC coding certification, CCC certification/CCVTC cert are highly desire EPIC experience: charge entry and charge review experience required Strong Evaluation and Management (E/M) inpatient and outpatient coding experience Must reside in CA Profee ONLY – NOT HCC/risk adjustment, ASC, or facility coding Desire to convert to full-time employment Experience • 3 years’ experience working in a hospital or...

Job Description Job Description "All candidates must be directly contracted by ASK Consulting on their payroll and cannot be subcontracted. We are unable to provide sponsorship at this moment". Job Title: HCC Coder or Risk Adjustment Coder Duration: 03 Months (Possibility of Extension) Pay Rate: $27/hr on W2  Location: Remote Job Description: The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates complex medical conditions, determines compliance of medical documentation, identifies trends, and suggests improvements in data and processes for Continuous Quality Improvement (CQI). Key Job Functions: Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Client IFP Coding Guidelines and Best Practices, HHS Protocols and any additional applicable rule set. Utilize HHS Risk...

divh2Senior Medical Coder/h2pAt Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for Americas seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each members complete health history, we ensure better care at a lower costdelivering the highest value to those who need it most./ppWere building a modern operating model for medical codingone that connects Risk Adjustment, Payment Integrity, and Quality (STARS/HEDIS) into a single, data-driven system. This is a rare opportunity to work at the center of that transformation: ensuring compliant, high-quality coding today while helping design the workflows that will define how a plan of the future operates./ppAs part of the Office of the CEOs AI Ops initiative, youll combine deep subject matter expertise with an...

Job Description Job Description Description: Full Time, Remote Exempt / Salary Organization High Country Community Health (HCCH) is a federally funded Community and Migrant Health Center with medical locations in Watauga, Avery, Burke, and Surry Counties. The mission of HCCH is to provide comprehensive and culturally sensitive primary health care services that may include dental, mental and substance abuse services to the medically under-served population of Watauga, Avery, Burke, and Surry Counties and the surrounding rural communities. Supervisory Relationship: Reports to: Deputy CFO Job Summary and Responsibilities Provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and patient complexity of care. Utilizes knowledge of official coding guidelines, HCC standards, Risk Adjustment Factor (RAF)...

Job Summary Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. The coding process reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters. Coders are responsible for translating diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes that can be utilized for submitting claims to payers for reimbursement. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. Job Duties Reviews the content of the medical record for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses and procedures performed that explain the reason for service being provided or the admission and patient severity and comply...

The Lead Risk Adjustment Coder is a system support position who completes coding and abstracting of patient encounters for the purposes of analyzing and improving the accuracy of complexity capture. The specialist works closely with physicians, the Population Health quality and data teams, the coding teams in AMG and the hospital, and the compliance department to identify and deliver high quality and accurate risk adjustment coding. The Lead Risk Adjustment Coder will demonstrate strong understanding of ICD-10-CM, CPT, HCC, and HCPCS coding guidelines and practices for outpatient and inpatient coding. Education High school diploma or equivalent is required 2 years of completed college coursework is preferred Licensure/Certification Certified Professional Coder thru AAPC Certified in Risk Adjustment coding or willing to obtain within 6 months of hire Experience Proficient in ICD-10 coding with 3 years of experience in the outpatient or hospital coding...

Job Description Job Description Description: Southeast Primary Care Partners is seeking a dedicated and detail-oriented Certified Coder to join our dynamic team. The successful candidate will play a crucial role in accurately coding healthcare claims for reimbursements, ensuring compliance with federal regulations, and contributing to the efficiency and effectiveness of our healthcare services. Certified Coder reviews medical records to assure proper billing. Participates in audits to evaluate if all selected codes are accurate and develops methodologies to improve coding issues identified. Codes must meet QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Position Summary: Requirements: Key Responsibilities: Review patients' medical records to extract relevant information needed for billing and coding. Apply appropriate ICD-10, CPT, and HCPCS Level II code assignments to ensure accurate and timely billing. Work closely with healthcare...

divh2Senior Medical Coder/h2pAt Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for Americas seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each members complete health history, we ensure better care at a lower costdelivering the highest value to those who need it most./ppWere building a modern operating model for medical codingone that connects Risk Adjustment, Payment Integrity, and Quality (STARS/HEDIS) into a single, data-driven system. This is a rare opportunity to work at the center of that transformation: ensuring compliant, high-quality coding today while helping design the workflows that will define how a plan of the future operates./ppAs part of the Office of the CEOs AI Ops initiative, youll combine deep subject matter expertise with an...

Job Description - Pro Fee Coder - Hospitalist The Pro Fee Coder - Hospitalist will review clinical documentation to assign and sequence diagnostic and procedural codes for hospital-based inpatient and observation encounters to meet the requirements of physician billing and reimbursement. This role focuses on professional fee (pro-fee) coding for hospitalists, ensuring accurate Evaluation & Management (E/M) coding for initial, subsequent, and discharge visits, as well as compliant documentation to support medical necessity and coding integrity. The Coder performs documentation review and assessment for accurate abstracting of clinical data and may interact with providers and clinical staff for clarification and education. DUTIES AND RESPONSIBILITIES: Select and assign ICD-10-CM and CPT/HCPCS codes for hospitalist services, including: Initial hospital care Subsequent daily visits Discharge management Observation and admission-to-discharge same-day...

REMOTE position Submission Requirements AAPC certificate required; MUST be CPC, CPC-H and/or COC Proficiency in AT LEAST 3 of the following: Specialty Clinics ( Med Spec Inject, Anticoag Management, Nutrition/Oncology Nutrition, Newborn/Lactation, OP Orthotic Prosth, Urology, Apheresis, Cardiac Rehab, General Surgery, Int Pain Healing, Non Inv Cardiology, Outpatient General Surgery, Proctology, Plastic Surgery, Endocrine, Benign Gyn, Infectious Disease, Neurosurgery, Oral & Facial Surgery, Ortho Total Joint, RAD CT, RAD MRI, RAD MRI, Trauma, Amputation Clinic, Burn Clinic, Dermatology, Endocrine Surgery, ENT Clinic, GI and Liver Disease, Gyn Dysplasia, Internal Medicine, Mineral Metabolism, Ortho Foot & Ankle, Pain, Burn Outpatient, Hand Surgery, Cardiology, Comprehensive Wound, Neurology, Pulmonology Clinic, Rheumatology, Eye Clinic, Access Clinic) must be able to handle HIGH Volume of cases Evaluation Management experience required Hospital...

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring...

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients. Job Summary Our client is seeking a Risk Adjustment Coder to act as the clinical coding subject matter expert and lead coding resource across the organization. The primary responsibilities include ensuring accurate coding, appropriate reimbursement, and supporting data-driven insights that aid the broader organizational goals of the health plan. The candidate will work closely with internal and external partners to optimize risk adjustment performance and provide education to providers on clinical coding standards. Responsibilities / Job Duties Act as the clinical coding subject matter expert and lead coding resource across the organization. Provide education to providers on clinical coding standards. Ensure accurate coding, appropriate reimbursement, and data-driven insights support organizational goals. Collaborate to optimize risk...

Description Summary: Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The 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 Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is an on-site position with a remote option. Responsibilities: Perform Medical Record reviews and audits based on organizational priorities. These can include both prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk adjustment....

Hcc (Hierarchical Condition Category) Coder Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code...

Job Type Full-time Description University Health Network is looking for a full-time Certified Medical Coder to focus on risk adjustment for the clinically integrated network associated with The University of Tennessee Medical Center and University Physicians' Association. This position requires normal business hours Monday-Friday. This is a remote position with occasional on-site meetings . Candidate must be able to maintain HIPAA privacy requirements when working from home. Candidate must be located in the Knoxville, TN region. This role involves performing detailed clinical documentation and risk adjustment reviews and accurately coding procedures and diagnoses using ICD-10-CM, CPT, HCPCS, and modifiers for professional services associated with The University of Tennessee Medical Center and University Physicians' Association. Essential Duties and Responsibilities (this list does not include all duties assigned) Performs coding services while meeting...

Job Description: Job Description POSITION PURPOSE This position is responsible for ongoing risk adjustment improvement activities Under general supervision this position includes ongoing quality improvement activities to ensure the organization's Risk Adjustment programs are implemented and meet all government requirements. NATURE AND SCOPE This role does not manage people This job reports to: Departmental Leadership Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with: All levels of BCBSLA personnel; physicians and their office personnel; hospitals and allied health provider administration, personnel and third-party medical record vendors; other Blue Plans; Client Association and contracted vendors. QUALIFICATIONS Education High School Diploma or GED required Work Experience 3 years of medical coding experience required with experience in risk adjustment preferred 1 year medical coding audit experience preferred...

Job Description:At ElevaIT, we're currently looking for a Senior Specialty Physician Coder for a 3Months Contract with our direct client. Job Title: Senior Specialty Physician Coder Location: Remote Duration: 3Months (Possibility of conversion into FT) Job Type: Contract Top SkillsSurgical breast oncology (including plastic reconstructive breast surgery), Hematology/OncologyMust be able to abstract the chart review to capture all billable chargesStrong chemotherapy and infusion experienceCHONC coding certification is highly desireEPIC Experience: charge entry and charge review experience requiredStrong Evaluation and Management (E/M) inpatient and outpatient coding experienceMust reside in CAProfee ONLY - NOT HCC/risk adjustment, ASC, or facility codingDesire to convert to full-time employment Bonus/nice to have Bonus: GYNONC coding experienceBonus: Experience working on denialsBonus: GI (CGIC coding certification) or OBGYN (COBGC coding certification) coding experience (1 year or...

Medical Coding Specialist II - Profee ED/Multispecialty 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. Be part of something remarkable. Join the #1 hospital in Wisconsin! 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) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician...

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring...