591 risk adjustment coder 1 jobs found

Job Description Please Note: This is a hybrid position ; however, applicants must reside in California and live within a 2-hour radius of Redlands, CA to be considered. Department: UHC: Managed Care 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...

Become a part of our caring community The Medical Coder / Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you will Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements. Identify educational needs based on reports Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques. Provider onsite education, based on business needs Collaboration with other market provider facing role Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards. Analyze coding audit results and other relevant data to develop data-driven educational materials and...

Description: Join the Team at PedIM Healthcare! Delivering exceptional care, together. Who We Are PedIM Healthcare is the first private medical office of its kind in Citrus County offering top-quality care for children, adults, and seniors all under one roof. We provide pediatric, adult internal medicine, family practice, geriatrics, womens care, medical weight-loss, sleep-medicine services and more. Our dedicated, community-focused team is committed to excellence, pride in service, and making a real difference for patients and families across Citrus County. Why Work With Us? A broad, multi-discipline practice where you can grow: pediatrics, internal medicine, weight-loss & sleep medicine specialties. A values-driven environment: we listen, we help, we understandand we care. Community-oriented and recognized: voted best of the best in the region. Opportunity to make a meaningful impact by supporting patients over their full life spanfrom...

Become a part of our caring community The Medical Coder / Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you will Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements. Identify educational needs based on reports Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques. Provider onsite education, based on business needs Collaboration with other market provider facing role Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards. Analyze coding audit results and other relevant data to develop data-driven educational materials and...

Become a part of our caring community The Medical Coder / Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you will Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements. Identify educational needs based on reports Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques. Provider onsite education, based on business needs Collaboration with other market provider facing role Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards. Analyze coding audit results and other relevant data to develop data-driven educational materials and...

Job Description Job Description Porter is hiring a Risk Adjustment Coder to join our Team!   Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience.    Position Overview We are seeking a certified coder with expertise in risk adjustment coding and...

Humana Inc in Frankfort is seeking a Senior Market Consultation / Partnership Professional to support the Clinical Support Team initiatives. This role is crucial in promoting accurate and compliant documentation and coding practices that enhance program quality in risk adjustment. The ideal candidate will need a valid RN license, be a certified coder, and possess strong knowledge in ICD-10-CM coding guidelines. This position allows for remote work with occasional office travel and offers a competitive salary range of $86,300 - $118,700 annually along with comprehensive benefits. #J-18808-Ljbffr

Humana Inc. is looking for a Senior Market Consultation / Partnership Professional (Nurse Medical Coder) to support Clinical Support Team initiatives. The role involves ensuring accurate documentation and coding practices across risk adjustment. Primary responsibilities include performing medical record reviews, validating diagnosis coding, and collaborating with clinical teams to improve documentation standards. An active RN license and a CPC are required, with an emphasis on excellent communication skills and data analysis proficiency. This position offers a competitive compensation ranging from $86,300 to $118,700 per year and is eligible for a bonus incentive plan. #J-18808-Ljbffr

Humana Inc. is looking for an IPA Consultative Coder to support high-quality care delivery in Corpus Christi, Texas. In this hybrid role, you will educate providers on coding practices, conduct audits, and enhance documentation accuracy. The ideal candidate has over 3 years of risk adjustment medical coding experience and necessary certifications. This position offers a competitive salary range of $59,300 - $80,900 per year and is eligible for a bonus incentive plan. Humana provides extensive benefits, including medical, dental, vision, and time off. #J-18808-Ljbffr

Humana Inc in Charleston, WV is hiring a Senior Market Consultation / Partnership Professional. This role focuses on ensuring accurate documentation and coding practices for risk adjustment programs, engaging with clinical teams and providers for continuous improvement. Candidates should possess an active RN license (BSN preferred) and coding certifications such as CPC. A strong understanding of ICD-10-CM coding and risk adjustment methodologies is essential for this position. #J-18808-Ljbffr

Description: Join the Team at PedIM Healthcare! Delivering exceptional care, together. Who We Are PedIM Healthcare is the first private medical office of its kind in Citrus County offering top-quality care for children, adults, and seniors all under one roof. We provide pediatric, adult internal medicine, family practice, geriatrics, womens care, medical weight-loss, sleep-medicine services and more. Our dedicated, community-focused team is committed to excellence, pride in service, and making a real difference for patients and families across Citrus County. Why Work With Us? A broad, multi-discipline practice where you can grow: pediatrics, internal medicine, weight-loss & sleep medicine specialties. A values-driven environment: we listen, we help, we understandand we care. Community-oriented and recognized: voted best of the best in the region. Opportunity to make a meaningful impact by supporting patients over their full life spanfrom...

Humana Inc is seeking a Senior Market Consultation / Partnership Professional to ensure accurate, compliant, and complete documentation and coding practices across risk adjustment initiatives. This remote position involves medical record reviews, coding validation, and collaboration with clinical teams to improve practices. The successful candidate will hold an active RN license or equivalent and a CPC, CRC, or CCS certification, demonstrating strong ICD-10-CM knowledge and data analysis skills. #J-18808-Ljbffr

Medical Coder Inspire health. Serve with compassion. Be the difference. Job Summary Codes medical information into the Prisma billing/abstracting systems using established professional and regulatory coding guidelines. Ensures that each diagnosis present on admission (POA) indicator is assigned appropriately. Codes for multiple facilities. Adheres to Prisma Health Coding and Compliance policies and procedures for assignment of complete, accurate, timely and consistent codes. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference. Codes medical information into the Prisma billing/abstracting systems using established professional and regulatory coding guidelines. Performs Inpatient coding including major traumas and Neonatal Intensive Care Unit (NICU) records by assigning International Classification of Diseases (ICD) and International Classification of...

At Suvida Healthcare, we are not just caregivers; we’re compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well‑being of an underserved community and their families. Our multi‑disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare‑eligible Hispanic seniors. Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service‑centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos , to help achieve our Higher Purpose? What Makes Us Unique We are an empowered...

Suvida Healthcare in Wisconsin is looking for a Risk Adjustment Coder to improve documentation and coding accuracy for Medicare-eligible seniors. The role involves coordinating chart reviews and working closely with the primary care team. The ideal candidate must have experience in ICD-10 coding and outpatient primary care coding, alongside excellent educator skills to assist providers in documentation practices. Join us to make a meaningful impact! #J-18808-Ljbffr

Become a part of our caring community The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

Job Description Job Description Description: This is a flexible CMS HCC/Risk Validation Audit role for a seasonal project. Other opportunities for continued work may be available at the conclusion of the project. Full time opportunities are available at either 30 or 40 hours weekly. Flexible work hours - nights and weekends are acceptable. Coders will review member and claim data validation aspects, which include: Member name, Member DOB, Gender, Dates of service, claim type, and provider signature Coders will be presented with all risk-adjusting diagnoses billed on a claim for a particular date of service or inpatient stay Must be able to identify acceptable provider specialty Coder must have knowledge of ICD-10-CM IP and OP coding Coders will confirm or not confirm each diagnosis Coders will add risk-adjusting diagnoses that are valid but not reported Requirements: Active certification through AAPC or AHIMA is required Minimum 5 years verifiable risk...

Humana Inc. is looking for a Senior Market Consultation / Partnership Professional (Nurse Medical Coder) in Des Moines, Iowa. This role supports Clinical Support Team initiatives to enhance documentation and coding practices within risk adjustment. Responsibilities include conducting medical record reviews, validating diagnosis coding, and providing coder education. The ideal candidate will have an active RN license and coding certifications, along with excellent communication skills. The position offers a salary range of $86,300 - $118,700 per year and is eligible for bonuses. #J-18808-Ljbffr

Kids for the Future in Leesburg, FL is seeking an HCC Risk Coder to support chart reviews and audits. This role demands expertise in HCC coding to accurately document and validate medical records. Responsibilities include data extraction, training staff on coding guidelines, and improving clinical documentation. The position offers comprehensive medical insurance, retirement plans, and generous paid time off. A high school diploma and two years of relevant experience are required, with certifications preferred. #J-18808-Ljbffr

Become a part of our caring community The Medical Coder / Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you will Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements. Identify educational needs based on reports Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques. Provider onsite education, based on business needs Collaboration with other market provider facing role Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards. Analyze coding audit results and other relevant data to develop data-driven educational materials and...

Location: 700 West Main Street, Leesburg, FL, 34748, United States Employee Type: FT Non-Exempt Required Degree: High school Manages Others: No Contact information Name: HR Phone: 352-600-5017 Welcome to Pathways Health Partners, the Accountable Care Organization (ACO) that's leading the charge in helping independent providers transition to Value-Based Care. What We Do: Medicare REACH ACO: We're at the forefront of Medicare innovation. Medicare Advantage MSO: Providing top-notch services to our Medicare Advantage patients. Commercial MSO: Managing care for approximately 16,000 patients across North-West/Central Florida. Where We Operate: From The Villages to St. Petersburg, and across to Mount Dora, we've got you covered! Our Services: Hospital Medicine Group: Delivering exceptional care in hospitals. Affiliated Medical Practices: Managing several top-tier medical practices. Insurance Agency: Offering comprehensive insurance solutions. Join us on our journey to...

Become a part of our caring community The Medical Coder / Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you will Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements. Identify educational needs based on reports Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques. Provider onsite education, based on business needs Collaboration with other market provider facing role Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards. Analyze coding audit results and other relevant data to develop data-driven educational materials and...

Become a part of our caring community The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...