40 risk adjustment clinical nurse coder jobs found

City/State Doral, FL Work Shift First (Days) Overview: AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA in Doral, FL! Status: Full-timepermanent position (40 hours) Standard working hours: 8am to 430pm EST, M-F Location: This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary Then Risk Adjustment Clinical Coder/Nurse 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...

## Clinical Documentation Improvement Nurse Coder (Certified)Applylocations: Portland, MEtime type: Full timeposted on: Posted 2 Days Agojob requisition id: REQ-2026-227Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.## Position SummaryThe Clinical Documentation Improvement (CDI) Nurse Coder supports accurate and complete clinical documentation that reflects the severity of illness, quality...

Join Care Synergy and be part of a mission-driven organization dedicated to elevating care, advancing wellness, and strengthening the communities we serve. Our collaborative, supportive team works across hospice, palliative care, PACE, CAPABLE, and community-based wellness services to advance excellence for patients, participants, families, and those who care for them—all while offering excellent benefits and meaningful opportunities to grow and make an impact. Care Synergy is looking for a Senior Medical Coding Specialist . LOCATION: Denver, CO STATUS: Full-time SCHEDULE: Monday-Friday; 8am-5pm PAY RANGE: $71,489 - $83,990 SUPPLEMENTAL PAY: Based on position, schedule and/or availability: Paid Mileage/Shift Differentials/Stipends/Overtime CULTURE, BENEFITS AND PERKS: We value engagement, community, and outreach initiatives and know it matters for our team members and our patients. We provide welcoming and supportive care to our patients and a...

General Summary: This role focuses on the Risk Adjustment process that supports the documentation of acuity diagnoses for the Managed Care (MC) patient population and required activities for submission of records to Medicare Advantage (MA) payers under established capitated contracts. It assists with medical record reviews for HCC diagnoses, correct usage of various coding guidelines (ICD-10-CM, CPT, HCPCS) and federal and MA payor regulations, as well as clinical validation of appropriate supporting documentation. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be done accurately and in a timely manner. Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers. Must always adhere to customer service expectations including in-person and virtual (via...

About Start Corporation Start Corporation is a 501(c)(3) non-profit organization founded in 1984. Our Mission is to promote opportunities, which enhance the self-sufficiency of people to empower them to live and function independently. Job Description We are looking for an experienced Medical Coder to join our team. Minimum Requirements High school diploma or equivalent required. Minimum 2-3 years of professional medical coding experience preferred. Completion of an accredited medical coding or medical billing and coding program preferred. Demonstrated knowledge of ICD-10-CM, CPT, HCPCS, E/M coding, Medicare and Medicaid coding requirements, and medical necessity. Knowledge of medical terminology, anatomy, and healthcare documentation. Experience with electronic health records and healthcare billing systems preferred. Experience reviewing provider documentation and resolving coding discrepancies. Core Competencies Ability to interpret payer policies,...

Description The Inpatient Coder II reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. Possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. Has a deep understanding of disease process, anatomy/physiology, pharmacology and medical terminology. RESPONSIBILITIES: Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity...

Nurse Auditor Coder (RN + CRC or CIC) | Clinical Claim Review | Weekdays | 100% Remote 100% Remote, U.S.-based  |  1099 Independent Contractor  |  Monday–Friday  |  Minimum 15 hours per week Before applying, please confirm that you meet all three requirements below. Applications that do not meet each of them will not be considered. An active, unencumbered RN license in the United States. An active CRC (Certified Risk Adjustment Coder) or CIC (Certified Inpatient Coder) credential in good standing. Availability for at least 15 hours per week, Monday through Friday, between 8:00 am and 8:00 pm Eastern, scheduled in blocks of at least four hours. About MHMDAA Michael Hill, MD and Associates (MHMDAA) is a clinical consulting firm specializing in expert witness opinions for payer–provider claim disputes. Law firms and insurers rely on Dr. Michael Hill and our clinical team for defensible opinions on medical necessity, coding and billing accuracy, regulatory...

This is a remote based position. Applicants can be located nationwide Inpatient Medical Coder #2922 United States Position Description About You You are a person who is passionate about interpreting health record documentation using your knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to determine appropriate diagnosis and procedural coding. We need someone who has a deep understanding of coding conventions, instructions, and Official Guidelines for Coding and Reporting and Coding Clinics. In the role of Inpatient Medical Coder, you will be responsible for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex, inpatient acute care discharges. - Tell us about your experience with Inpatient Medical Coding. - Are you a team player and a self-motivator? - What is your experience with conducting business in a way that is credit to a company? - We are counting on you to manage multiple projects using your...

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 limited to: Customer Service,...

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 limited to: Customer Service, Claims...

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...

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 Service, Claims...

Martin's Point Health Care Inc. in Portland, Maine, is seeking a Clinical Documentation Improvement Nurse Coder (Certified) to ensure accurate documentation, optimize risk adjustment, and support quality reporting. The role requires RN licensure, CDI experience, coding certifications, and strong collaboration with providers and care teams. This full-time role emphasizes documentation integrity and regulatory compliance to improve population health outcomes. #J-18808-Ljbffr

Job Description Job Description Overview This is a temporary position for approximately 6 months. Responsibilities The Risk Adjustment Coder is responsible for providing support to the Risk Adjustment Department. This position will work closely with the VBC Risk Director, Program Managers, (Nurse Practitoners) NPs and external vendors to assist with managing the Chronic Disease Managed Visit (CDMV) Program through coding charts and queries.     Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.   Collaborate with Lead Coder to review CDMV progress notes and CDMV Summary Continuous streamlined communication with NPs on queries as needed Weekly meeting with Lead coder to discuss any barriers on receiving responses to queries or any questions regarding coding Stay up to dates with CMS Coding Guidelines as identified for Risk Adjustment (CPT and ICD codes) Collaborate with coordinators and specialists for adhoc...

Join Our Caring Community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities: Deliver coding and documentation education to providers and clinic staff within IPA clinics. Be a consultative resource and ongoing support for providers in assigned clinics. Conduct documentation audits to identify gaps, trends, and opportunities for improvement. Perform quarterly chart reviews to support coding accuracy...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient medical records....

Company Overview :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 codes, ensuring compliance with coding guidelines, third-party reimbursement policies, and accreditation standards.This role...

Join Our Caring CommunityHumana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market.ResponsibilitiesDeliver coding and documentation education to providers and clinic staff within IPA clinics.Be a consultative resource and ongoing support for providers in assigned clinics.Conduct documentation audits to identify gaps, trends, and opportunities for improvement.Perform quarterly chart reviews to support coding accuracy and...

Location Address: Remote OfficeSanta Fe, NM 87501 Compensation Pay Range: Minimum Offer $24.27Maximum Offer $41.33Now Hiring: HCC Coder with CRC Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Remote PRN HCC Coder with CRC to join our team.Type of Opportunity: Full timeJob Exempt: NoJob is based: Remote Workers New MexicoWork Shift: Varied Days and Hours (United States of America) Responsibilities: Codes more than one of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers for the purpose of reimbursement, research and in compliance with Federal regulation according to diagnosis, operation and procedure using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and Procedures Some key responsibilities include: Reviews patients entire current medical record, assigning...

Become a part of our caring community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities: You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will...

Overview Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will perform quarterly chart reviews to...

Location Address: Remote OfficeSanta Fe, NM 87501 Compensation Pay Range: Minimum Offer $24.27Maximum Offer $41.33Now Hiring: HCC Coder with CRC Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Remote PRN HCC Coder with CRC to join our team.Type of Opportunity: Full timeJob Exempt: NoJob is based: Remote Workers New MexicoWork Shift: Varied Days and Hours (United States of America) Responsibilities: Codes more than one of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers for the purpose of reimbursement, research and in compliance with Federal regulation according to diagnosis, operation and procedure using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and Procedures Some key responsibilities include: Reviews patients entire current medical record,...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient medical...

Consultative Medical CoderThe Consultative Medical Coder provides medical coding expertise to support clinical staff (Physicians and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding. This is a predominantly remote position, but you must live in the Las Vegas area and be able to travel to assigned clinics on an as-needed basis, which equates to approximately one week per month. You will report to the Manager, Medical Coding.Responsibilities:Cultivate relationships with clinicians to serve as the single contact for questions and issues relating to documentation and coding.Identify documentation improvement areas and partner with clinical and coding education to deliver education related to improvement opportunities.Perform Quality Assurance on post-visit reviews.Manage the special handling of Mergers & Acquisitions by performing problem list cleanup and conducting process training on documentation...