19 crc certified risk adjustment coder jobs found in Monterey Park, CA

Astrana Health, Inc. is seeking a Certified Risk Coder to support value‑based care and risk adjustment through accurate diagnoses, coding reviews, and CMS guideline compliance with clinicians. This remote US‑based role requires CRC credential and 2+ years in risk adjustment or HCC coding, ICD‑10‑CM proficiency, and experience with EHRs. Salary ranges from $56,000 to $85,000 annually, with West/Central time zone preference. #J-18808-Ljbffr

Northeast Community Clinic is seeking an HCC Coder to evaluate accuracy and consistency of coded clinical data, collaborating with Billing Manager and Medical Director on ICD-10-CM, CPT, E/M, and documentation to ensure compliant outpatient coding. The role involves reviewing medical records, training staff on Medicare coding guidelines with emphasis on HEDIS and Risk Adjustment HCC, and leading coding process improvements. Some evening/weekend hours may be required in a full-time capacity. #J-18808-Ljbffr

NECC is seeking a detail‑oriented HCC Coder to ensure accurate outpatient coding and documentation. You will work with Billing and Medical Director to apply ICD-10-CM, CPT, HCPCS and HCC guidelines, promoting quality measures and risk adjustment accuracy. You will review records for accuracy, educate staff on Medicare rules, and lead coding process improvements, with travel up to 10% for facility coverage as needed. #J-18808-Ljbffr

Job Description The HCC Coder will be responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. The HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services. Schedule Full-time (Non-Exempt) Flexible, may require some evening and weekends Primary Duties and Responsibilities Review of medical records to ensure accuracy and claims for proper documentation and coding and completeness. Communicate with providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes. Create training presentations to educate staff in Medicare coding guidelines, with focus on Quality Measures...

HCC CoderAdministration Office - Alhambra, CA 91801OverviewSalary Range $34.00 - $39.00 HourlyDescriptionPosition SummaryThe HCC Coder will be responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. The HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services.Schedule:Full-time (Non-Exempt)Flexible, may require some evening and weekendsPrimary Duties and ResponsibilitiesReview of medical records to ensure accuracy and claims for proper documentation and coding and completeness.Communicate with providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes.Create training...

HCC Coder Administration Office - Alhambra, CA 91801 Overview Salary Range $34.00 - $39.00 Hourly Description Position Summary The HCC Coder will be responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. The HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services. Schedule: Full-time (Non-Exempt) Flexible, may require some evening and weekends Primary Duties and Responsibilities Review of medical records to ensure accuracy and claims for proper documentation and coding and completeness. Communicate with providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for...

Job Title Support the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures in Risk Adjustment, CMS 5 Star, and the commercial and Medi-Cal programs. Principal Duties and Responsibilities (* = essential functions): Outreach and coordinate care for IPA members who need preventative and/or chronic care services such as mammograms, colonoscopies, uncontrolled HbA1c, uncontrolled blood pressure, etc. Collaborate with Risk Adjustment and quality on provider education. Maintain knowledge of clinical initiatives and risk adjustment program requirements Maintain knowledge of 5 Star performance and risk adjustment factors for all IPAs. Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports. Coordinate outreach to PCP offices on member due reports, including the No Annual Visits list. Provide PCP offices with ongoing education on quality measures Work...

Job Description Job Description Primary Purpose: Support the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures in Risk Adjustment, CMS 5 Star, and the commercial and Medi-Cal programs. Principal Duties and Responsibilities (* = essential functions): Outreach and coordinate care for IPA members who need preventative and/or chronic care services such as mammograms, colonoscopies, uncontrolled HbA1c, uncontrolled blood pressure, etc. Collaborate with Risk Adjustment and quality on provider education. Maintain knowledge of clinical initiatives and risk adjustment program requirements  Maintain knowledge of 5 Star performance and risk adjustment factors for all IPAs. Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports. Coordinate outreach to PCP offices on member due reports, including the No Annual Visits list. Provide PCP offices with ongoing...

Astrana Health is seeking a Risk Adjustment Coding Specialist to support Orange County operations. You will conduct high-volume chart reviews to identify coding gaps, then translate findings into education for providers and practice leaders, driving HCC recapture and KPI improvements. olla You will travel to provider offices up to 75% and collaborate with IPA teams, offering auditing and education to ensure CMS, Medicare and payer guidelines are met while staying current on ICD-10/HCC updates. #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

Job Description Job Description Description The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement. Our Values:  Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Review medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and...

Certified Risk Coder Department: Quality - Risk Adjustment Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation: $56,000 - $85,000 / year Description The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement. What You'll Do Review medical records and provider documentation to ensure accurate capture of risk-adjusting...

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....

Certified Risk CoderThe Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement.Our Values:Put Patients FirstEmpower Entrepreneurial Provider and Care TeamsOperate with Integrity & ExcellenceBe InnovativeWork As One Team

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. The Remote Risk Adjustment Compliance Auditor is to conduct provider and coder level reviews and audits to ensure accurate risk adjustment data is being submitted to the CMS. Develops and maintains tracking tools, reviews and audits outcomes / findings and monitors any corrective active plans implemented due to review or audit findings. Monitors...

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.The Remote Risk Adjustment Compliance Auditor is to conduct provider and coder level reviews and audits to ensure accurate risk adjustment data is being submitted to the CMS. Develops and maintains tracking tools, reviews and audits outcomes / findings and monitors any corrective active plans implemented due to review or audit findings. Monitors...

Job Description Job Description Description The 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 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...

Job Type Full-time 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 include the following: Analyze data from contracted IPA network providers that allows...

DRG CoderThe 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 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.