43 hcc risk adjustment coder icd 10 expert jobs found

DATE: July 20, 2026 POSITION: Risk Adjustment Compliance Coder DEPARTMENT: Finance-Risk Adjustment RATE: $28.86 per hour, with potential for additional compensation based on qualifications. POSITION SUMMARY: The Risk Adjustment Compliance Coder is responsible for enhancing the accuracy, quality, and integrity of coding data that supports Medicare and Medicaid reimbursement. This role conducts risk adjustment coding audits, performs compliance research, responds to coding inquiries, and serves as a subject matter expert in risk adjustment coding and compliance. The position supports Medicare and Medicaid risk adjustment programs through the development, implementation, and ongoing evaluation of program initiatives. Highly collaborative and operational in nature, this role partners closely with providers and internal stakeholders and requires strong communication, education, and relationship‑management skills. This is not a traditional production‑focused coding position. ESSENTIAL...

## Risk Adjustment CoderApplyremote type: Hybridlocations: SMG Administrationtime type: Full timeposted on: Posted Todayjob requisition id: JR-103351**City/State**Virginia Beach, VA**Work Shift**First (Days)**Overview:**# **Overview**Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training,...

About Us: 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....

About Us: 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....

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. University Health Networ k is seeking a full-time Certified Medical Coder to join our team. This role involves performing detailed clinical documentation and risk adjustment reviews and accurately coding HCC diagnoses using ICD-10-CM guidelines. CPT and E/M experience is not required for this role. Essential Duties and Responsibilities (this list does not include all duties assigned) Performs coding services while meeting daily production and quality goals Conduct thorough reviews of clinical documentation to ensure accuracy and compliance with coding standards. Assign appropriate ICD-10-CM, CPT, HCPCS, and modifiers for professional services. Collaborate with healthcare providers to clarify diagnoses and procedures to...

About Us: 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. Job Overview 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...

Summary: This position is accountable for accurately reviewing, interpreting, auditing, coding, and analyzing medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction. Review may include inpatient, outpatient treatment, and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business. Responsibilities: Understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction. Review medical records for completeness, accuracy, and compliance with applicable coding guidelines and regulations. Identify, compile, and code member/patient data using ICD-9/ICD 10-CM and other standard classification coding systems. Support the...

Job Title Risk Coder Location Virginia Beach, VA Work Shift First (Days) Job Description Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training, monitoring, & auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. Performs...

How You’ll Make An Impact At Strive Health, patients come first. We’re on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You’ll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday. If you’re looking for meaningful work where your contributions truly matter, you’ll feel right at home at Strive! Benefits & Perks Hybrid-Remote Flexibility – Work from home while fulfilling in-person needs at the office, clinic, or patient home visits. Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts. Financial & Retirement Support –...

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. Review...

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. Why Join Us? We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting...

To support a growing healthcare practice, the remote Certified Clinical Coder will ensure accurate documentation of patient complexity, validate diagnosis codes, and collaborate with clinical teams to uphold coding excellence, all while maintaining compliance and confidentiality. Key responsibilities Apply expert coding judgment using ICD 10 guidelines to validate diagnosis codes in medical records Analyze MRA reports and query providers for clarification to strengthen documentation accuracy Collaborate across teams to ensure seamless workflows and support timely amendments through ongoing review processes Required qualifications Professional Coder (CPC) Certification 3+ years of experience in CMS-HCC risk adjustment or HCC coding 3+ years of ICD 10 coding experience 1+ year of HEDIS/Stars experience Strong knowledge of medical terminology, anatomy, physiology, and disease processes

About Us: 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....

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....

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values. Why Join Us? We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Risk Adjustment Coding Auditor is responsible for...

Certified Risk Adjustment Medical Coder (CRC) Key Details Location: 100% Remote (Must reside in an approved state) Duration: Contract (Potential for extension) Schedule: Monday-Friday, 7:00 AM-4:00 PM or 8:00 AM-5:00 PM (Local Time) Hours: 40 hours per week, with 5-10 hours of overtime as needed (Candidates must be willing to work overtime) Work Arrangement: Fully Remote Compensation: $27.00 per hour Employment Type: W2 (Not open to C2C, 1099, or visa sponsorship) Role Overview Our client is seeking an experienced Certified Risk Adjustment Medical Coder (CRC) to support CMS and HHS Risk Adjustment Data Validation (RADV) audits. This position is responsible for reviewing inpatient and outpatient medical records to validate Hierarchical Condition Categories (HCCs) while ensuring compliance with CMS documentation standards, ICD-10 coding guidelines, and regulatory requirements. The ideal candidate will have extensive experience performing CMS...

Certified Risk Adjustment Medical Coder (CRC) Our client is seeking an experienced Certified Risk Adjustment Medical Coder (CRC) to support CMS and HHS Risk Adjustment Data Validation (RADV) audits. This position is responsible for reviewing inpatient and outpatient medical records to validate Hierarchical Condition Categories (HCCs) while ensuring compliance with CMS documentation standards, ICD-10 coding guidelines, and regulatory requirements. The ideal candidate will have extensive experience performing CMS and HHS RADV audits, vendor-side coding reviews, and risk adjustment auditing while maintaining exceptional coding accuracy and productivity standards. Key Responsibilities Review inpatient and outpatient medical records to validate HCC diagnoses. Determine whether submitted diagnosis codes meet CMS and HHS documentation requirements. Ensure documentation satisfies M.E.A.T. (Monitor, Evaluate, Assess, Treat) criteria. Perform coding reviews using ICD-10...

Maternal Fetal Medicine (MFM) Professional Coder Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. We are seeking an experienced Maternal-Fetal Medicine (MFM) Coder to manage high-risk OB coding. This role requires mastery of complex Chapter 15 ICD-10-CM guidelines and specialized fetal procedures. The role requires audit, review, and coding complex maternal and fetal anomalies. Ideal candidate will understand the nuances of global vs. split-care billing, complex E/M guidelines, and specialized fetal therapy procedures. This is a high-level position for an expert coder who can operate independently. Independently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant...

Maternal Fetal Medicine (MFM) Professional Coder Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. We are seeking an experienced Maternal-Fetal Medicine (MFM) Coder to manage high-risk OB coding. This role requires mastery of complex Chapter 15 ICD-10-CM guidelines and specialized fetal procedures. The role requires audit, review, and coding complex maternal and fetal anomalies. Ideal candidate will understand the nuances of global vs. split-care billing, complex E/M guidelines, and specialized fetal therapy procedures. This is a high-level position for an expert coder who can operate independently. Independently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant...

Our Client, a Healthcare company, is looking for a Senior Specialty Physician Coder - Interventional for their Fountain Valley, CA location. Responsibilities: Achievement of productivity standards as established by management. Achievement of quality standards as established by management. In adherence with standard work, analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS codes to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines, including the ability to review and natively code surgical operative and/or procedure reports. In adherence with standard work, follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark...

Clinical Documentation Integrity Specialist (Coder) Remote within the U.S.; preference for those located in Eastern or Central time zones. Office Hours: Monday–Friday, 8am–5pm About Us Greenbrook Medical is building the new standard in primary care. We deliver high-touch, relationship-based care through neighborhood clinics, grounded in a simple belief: every senior deserves the kind of care we would want for our own families. Our model prioritizes time with patients, strong care coordination, and a personalized approach that improves outcomes while lowering total cost of care. We take full accountability for patient outcomes and overall cost of care, aligning clinical excellence with disciplined execution. That commitment shows up in our results, including a patient Net Promoter Score of 91, compared to 32 for typical healthcare organizations. Rooted in Tampa Bay and partnered with Tampa General Hospital, we are entering an exciting phase of growth. Backed by strong...

Clinical Documentation Integrity Specialist (Coder) Remote within the U.S.; preference for those located in Eastern or Central time zones. Office Hours: Monday–Friday, 8am–5pm About the Role As a CDI Coding Specialist, you ensure our documentation accurately reflects the complexity of the seniors we serve. Your work strengthens clinical accuracy, supports high‑quality care, and helps providers deliver the right care at the right time. This role is fast‑paced, detail‑driven, and deeply collaborative. You'll review charts, validate documentation, and partner with providers to uphold the highest standards of coding excellence. If you thrive in a mission‑driven environment that values teamwork, integrity, and accountability, you'll feel right at home here. What You'll Do Master the chart, start to finish Apply expert coding judgment using ICD‑10 guidelines to validate accurate diagnosis codes in medical record documentation Support the clinical care teams through...

Professional Coder I Our client, a Health Insurance company, is looking for a Professional Coder I for their Newark, NJ location. Responsibilities: This position is accountable for accurately reviewing, interpreting, auditing, coding and analyzing medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction. Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business. Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction. Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations....