Risk adjustment auditor coder jobs

Remote Risk Adjustment Coder & Auditor (CRC)

Medix New York, NY

Medix™ is looking for a Risk Adjustment Coder & Auditor to join its specialized team in New York, New Jersey, or Connecticut. This remote, full-time position requires 3–5 years of experience in HCC/Risk Adjustment coding, as well as dual certifications as a CPC, CCS, RHIT, or RHIA and a Certified Risk Adjustment Coder (CRC). You will be responsible for ensuring coding accuracy, preparing for quarterly audits, and improving documentation quality while maintaining a high standard of compliance. Comprehensive benefits and competitive compensation are offered. J-18808-Ljbffr

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Hybrid HCC QA Coder/Auditor — Risk Adjustment Expert

Blue Cross Blue Shield of Arizona Phoenix, AZ

A health insurance provider seeks a Quality Assurance Coder/Auditor based in Arizona to develop risk mitigation and education programs. Responsibilities include reviewing medical records, coding for accuracy, and educating providers on best practices. The position requires at least 5 years of coding experience, with proficiency in HCC coding, and certifications like CCS-P or CPC. This hybrid role promotes flexibility, allowing candidates to work both onsite and remotely within Arizona. #J-18808-Ljbffr

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Medical Coder & Quality Auditor - Risk Adjustment

Amazon Bellevue, WA

Amazon is looking for a Medical Coding Auditor for its Healthcare division based in Bellevue, Washington. The candidate will be responsible for leading quality initiatives, conducting training, and analyzing coding accuracy in a dynamic healthcare environment. Required qualifications include a Bachelor's degree, CPC or CCS certification, and at least one year of experience in outpatient and/or risk adjustment coding. Strong communication and analytical skills are essential, as is the ability to work independently and manage multiple projects. #J-18808-Ljbffr

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Hybrid QA Coder/Auditor - HCC & Risk Adjustment

Blue Cross Blue Shield of Arizona Phoenix, AZ

A regional health insurance provider in Phoenix seeks a Quality Assurance Coder/Auditor to develop risk mitigation programs and educate providers. The candidate should have 5 years of coding experience with expertise in Hierarchical Condition Categories (HCC). Responsibilities include medical record reviews, coding analysis, and providing education to healthcare professionals. The position requires residency in Arizona and offers a hybrid work environment, enhancing work-life balance. #J-18808-Ljbffr

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HCC Risk Adjustment Coder, Sr.

Regal Medical Group Los Angeles, CA

Hcc Risk Adjustment Auditor/Coder, Sr. We are looking for experienced HCC Risk Adjustment Auditors/Coders, Sr. to join our team! Position Summary: The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding documentation and data in the medical record and HCC database. The HCC Risk Adjustment/Auditor reports on the accuracy and consistency of the data in accordance with accepted and established standards. Risk Adjustment Auditors collaborate with the Manager to provide expertise in the use and application of coding classifications, such as ICD-9-CM and/or ICD-10-CM. Auditors also record documentation to ensure compliance in the collection of outpatient diagnoses and services. Essential Duties and Responsibilities include the following: Works as an integral member of the Finance Department. Code review super bills and patient medical...

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Senior Risk Adjustment Coder & CDI Auditor

Stanford Health Care - ValleyCare Stanford, CA

A healthcare organization is seeking a Senior Risk Adjustment Coder to perform code audits and compliance tasks. The ideal candidate should have over 5 years of experience and a solid understanding of coding guidelines. This role requires effective communication and problem-solving abilities to ensure accurate HCC coding while collaborating across departments. Competitive hourly salary range of $44.13 - $57.36 is offered. #J-18808-Ljbffr

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QA Coder/Auditor (Hybrid) — Risk-Adjustment Expert

Blue Cross Blue Shield of Arizona Phoenix, AZ

A leading health insurance provider in Arizona seeks a Quality Assurance Coder/Auditor to develop risk management and provider education programs. This hybrid role requires 5 years of professional coding experience, with 3 years focused on HCC coding. The ideal candidate will ensure coding accuracy in medical records and provide training to healthcare providers. Applicants must have a high school diploma and relevant certifications, with a preference for those with Medicare Advantage experience. #J-18808-Ljbffr

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...

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Coding Auditor, Facility

Scout Exchange OR

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),...

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...

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Medical Coding Compliance Specialist - Remote

Theoria Medical Novi, MI

Job Description Job Description Why Professionals Love Theoria Medical At Theoria Medical, accuracy, integrity, and collaboration matter. Our compliance and coding professionals play a critical role in supporting quality patient care while ensuring our clinical and billing practices remain aligned with evolving industry standards and regulations. We believe meaningful work should come with flexibility, support, and opportunities for growth. Our teams are empowered with advanced technology, collaborative leadership, and a mission-driven culture that values expertise and innovation. Build a career where your knowledge drives impact across a growing national healthcare organization. About Theoria Theoria Medical is leading the charge in healthcare innovation and quality of care — offering a unique blend of medical excellence and technological advancement, serving the post-acute sector. Our network includes multispecialty physician services covering skilled nursing...

UH

Coding Compliance Auditor (2223)

US Heart and Vascular Franklin, TN

Coding Compliance Auditor Fully Remote Overview Position Type Full Time Education Level High School Diploma/GED Category Other Positions Description US Heart and Vascular is in need of a Remote Coding Compliance Auditor to join our team. The Coding Compliance Auditor performs internal medical record audits and prepares compliance auditing reports, subsequent educational materials and training as directed by the Compliance and Privacy department. Audits include regular compliance medical record audits or focused review projects for ongoing review of coding and documentation for cardiovascular specialties to support compliance with coding and documentation rules and regulations. Responsibilities: Performs coding audits reviewing for compliance and accuracy with CPT, ICD-10, HCPCS and corporate coding policy and follows up for timely completion within designated time period. Maintains excellent documentation of all reviews, methodologies employed, results, corrective...

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Coder I

Health eCareers Los Angeles, CA

Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills. Ability to perform job duties using an electronic medical record system. Strong knowledge of anatomy, physiology and medical terminology. Knowledge of coding classification systems and procedures. Required Work Experience: For HIM coder, one (1) year hospital-based outpatient coding experience. For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System. Other Information: For HIM: Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) or Certified Coding Associate (CCA).For Physician Billing:...

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Coding Auditor/Educator

Southeast Primary Care Partners Alpharetta, GA

Job Type Full-time Description Job Title: Provider Coding Educator / Auditor Department: Revenue Integrity & Compliance Employer: Southeast Primary Care Partners / Southeast Medical Group, P.C. FLSA Status: Non-Exempt (Hourly) Position Summary The Provider Coding Educator/Auditor is responsible for driving accurate clinical documentation, compliant coding, and revenue integrity across Southeast Primary Care Partners' ambulatory practices. The role combines prospective and retrospective E/M, procedural and risk-adjustment auditing with in-person and virtual provider education. Up to 50 % regional travel is required to meet with physicians on flexible schedules, including early-morning huddles and occasional after-hours sessions. This is an hourly, non-exempt position governed by the Fair Labor Standards Act (FLSA) overtime provisions and subject to Occupational Safety and Health Administration (OSHA) workplace safety standards. Requirements Essential...

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Sr Coding Compliance Auditor

CommonSpirit Health Chattanooga, TN

Job Summary and Responsibilities The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement, and revenue capture. Provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings, webinars, and online modules. Develops, maintains and presents coding and compliance educational materials to staff and clinicians. Collaborates with the coding team to support the needs of the organization. The position will support risk adjustment improvement efforts across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS to promote quality care for Medical Advantage members. By focusing on comprehensive documentation to identify, evaluate and assess chronic conditions at the appropriate specificity, patient medical needs are met at the highest level. The Sr Coding Compliance Auditor's primary focus will be...

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Compliance Auditor - MPG - FT - Days - MHS

Memorial Health Care System Fort Lauderdale, FL

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements. Responsibilities: Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify...

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Permanent - Outpatient Facility Medical Coder

Healthcare Staffing Plus OR

JOB DESCRIPTION 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), and Kaiser Permanente organization/institutional coding...

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Inpatient Facility Medical Coder

Scout Exchange OR

Title - Inpatient Facility Medical Coder (40h Day) Location - Clackamas, OR, US Job Type - Permanent | Remote Required: Minimum five (5) years experience in coding with four (4) years inpatient facility coding The candidate must have 1 from the following list: Registered Health Information Technician Certificate Certified Coding Specialist Registered Health Information Administrator Certificate Advanced knowledge of medical terminology, pharmacology and medial coding principles for ICD-10-CM, ICD-10-PCS, HCPCS/CPT and coding. Advance knowledge of disease processes, diagnostic and surgical procedures, ICD-10-CM, ICD-10-PCS, HCPCS/CPT classification systems, health information/medical record department responsibilities with knowledge of government regulations and areas of scrutiny for potential fraud and abuse issues. Job description Candidates must reside either in Washintgon or Oregon to be considered for this position. To independently and efficiently...

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Coding Auditor, Facility

Veracity OR

Coding Auditor, Facility Onsite Clackamas, OR 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), and Healthcare...

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HCC Coder

TEKsystems Los Angeles, CA

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...

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Inpatient Facility Medical Coder

InstantServe LLC OR

Inpatient Facility Medical Coder Location: Clackamas, OR, US Pay Rate: USD $27.26 – $39.37 / hr + Benefits Essential Responsibilities: Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as needed for proper Ambulatory Payment...

UH

Sr Risk Adjustment Coder

University HealthCare Alliance Newark, NJ

Senior Risk Adjustment Coder The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC 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 Medicare Advantage Risk Adjustment. What you will do: Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses. Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes. Inquire with clinicians the recommended HCC diagnosis for chart addendum. Collaborating with other departments to address coding updates and support risk...

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Coder I - Billing & Audit - FT - Days - MSS - Hybrid Eligible

Memorial Healthcare System Hollywood, FL

Coding Specialist Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category),...

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Quality Assurance Coder/Auditor - Hybrid

Blue Cross Blue Shield of Arizona Phoenix, AZ

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa 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 limited to: Customer...

135 risk adjustment auditor coder jobs found