36 risk adjustment coder ii jobs found

A nonprofit managed care organization in Texas seeks a Risk Adjustment Coder II to conduct complex medical record reviews and ensure coding accuracy for various programs like Medicare risk adjustment. The ideal candidate will have a Bachelor’s degree or equivalent experience in risk adjustment, along with relevant certifications. The role requires strong analytical, written, and verbal skills, with at least 3-5 years of experience in risk adjustment coding. This position demands adherence to CMS guidelines and involvement in quality assurance processes. #J-18808-Ljbffr

About Us Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions. Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare...

A non-profit managed care organization in Texas is seeking a Risk Adjustment Coder II. This role involves conducting advanced medical record reviews, ensuring compliance with CMS guidelines, and providing coding expertise to support risk adjustment efforts. Candidates must possess a Bachelor's Degree or relevant coding certifications along with 3-5 years of experience in risk adjustment coding. Strong analytical and communication skills are essential for success in this position. This opportunity is only available to Texas residents. #J-18808-Ljbffr

A non-profit managed care organization in Texas is seeking a Risk Adjustment Coder II to conduct complex medical record reviews and code chronic conditions accurately. This role requires 3-5 years of experience in risk adjustment coding and relevant certifications. The ideal candidate will ensure compliance with coding guidelines and contribute to departmental goals. Strong analytical and interpersonal skills are essential, along with proficiency in Microsoft 365. This position supports high-quality healthcare access for members. #J-18808-Ljbffr

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions. Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription...

A non-profit managed care organization in Houston is seeking a Risk Adjustment Coder II to provide advanced support for medical record reviews and ensure accurate coding of chronic conditions. The ideal candidate will have a Bachelor's degree or extensive experience in risk adjustment, along with relevant coding certifications. Key responsibilities include coding compliance, conducting documentation reviews, and collaborating with various departments to improve accuracy. A strong background in coding standards and methodologies is essential for this role. #J-18808-Ljbffr

Community Health Choice, Inc. (Community) is a non‑profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women Children’s Health Insurance Program (CHIP) for the children of low‑income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions. Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription...

A healthcare organization in Monterey Park is seeking a Risk Adjustment Coding Specialist II to ensure compliance with risk adjustment documentation for Medicare. The position requires 3-5 years of experience in coding and maintaining certifications. Responsibilities include reviewing medical records, auditing coding accuracy, and training new staff. This role offers a hybrid work structure and requires travel to provider sites, with a competitive salary of $75,000 - $85,000 per year. #J-18808-Ljbffr

A healthcare company in California seeks a motivated Risk Adjustment Coding Specialist to ensure accurate coding compliance and provide education to providers. The role requires CPC and CRC certifications, alongside 3-5 years of relevant experience. Candidates should be proficient in Microsoft tools and willing to travel occasionally to Virginia for provider site visits. This position offers a hybrid work structure with competitive compensation ranging from $65,000 to $78,000 annually. #J-18808-Ljbffr

A healthcare organization in Houston seeks an experienced Value Based Coder II to conduct thorough reviews of patient medical records, focusing on Hierarchical Condition Categories (HCC). The role involves delivering provider education, participating in compliance monitoring, and contributing to performance improvement initiatives. Candidates should have a relevant bachelor's degree or equivalent experience, along with coding certifications. Strong knowledge of CPT and ICD-10 coding, risk adjustment models, and excellent communication skills are essential. #J-18808-Ljbffr

A leading healthcare organization in Houston is seeking a Value Based Coder II to join its Quality Management/Risk team. This role is crucial for reviewing patient medical records to identify coding opportunities and deliver provider education on HCC. Candidates should have a Bachelor’s degree or equivalent experience, with at least 5 years in healthcare and certification as a CPC, CCS, or CRC. Strong knowledge of coding guidelines and excellent communication skills are essential. This is an opportunity to contribute significantly to process improvement initiatives. #J-18808-Ljbffr

Risk Adjustment Coder 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. 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 a specialization in in-home health assessments. The ideal candidate will have a strong understanding of CMS risk adjustment and quality initiatives, exceptional...

Work Schedule: This is a full-time, 1.0 FTE position that is 100% remote. Applicants hired into this position can work remotely from most states. This will be discussed during the interview process. To be eligible to work remotely, you must be in an approved remote work state for UW Health. We've included a link below to view the full list of approved remote work states. Approved Remote Work States Listing Be part of something remarkable Join the #1 hospital in Wisconsin! We are seeking a Medical Coding Specialist II : Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching...

Coder II - ProFee Trauma Surgery Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments. Includes inpatient E/M coding and clinic E/M coding as well as trauma surgery coding and bedside procedure coding. Experience required in at least E/M coding or trauma surgery coding. Facility Specific: Responsible for coding SDS, Observation, and as needed ED, Diagnostic, and Ancillary records. Professional Fee Specific: Responsible for coding Surgical Records, Evaluation & Management Encounters, ED (with E&M) and as needed Diagnostic,...

Value Based Coder II The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk-adjusting conditions and supporting provider documentation improvement. 1. Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding. 2. Advanced Documentation...

Risk Adjustment Coder 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. 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 a specialization in in-home health assessments. The ideal candidate will have a strong understanding of CMS risk adjustment and quality initiatives, exceptional...

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...

Coder II ProFee ED Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments. Professional Fee Specific: Responsible for coding Surgical Records, Evaluation & Management Encounters, ED (with E&M) and as needed Diagnostic, Documentation Quality Assurance, and Ancillary records. Education: High School diploma or equivalent required. Experience: Minimum of 1 Year of outpatient multidisciplinary coding and or Provider E&M Level of Service Coding (Professional Fee Only) experience required. Certification: Minimum one coding...

Inpatient Coder II, HB Coding, Full-time, Days (Remote - Must reside in IL, IN, IA, WI, OH, MO, MI, or FL - Sign-on bonus eligible) 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. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. The Inpatient Coder II 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....

Medical Coder Multi-Specialty (Hospital & Clinic) Location: Kingwood-Hybrid Employment Type: Full-Time Reports To: Revenue Cycle Manager Position Summary We are seeking a highly skilled, detail-driven, and high-producing certified medical coder with multi-specialty experience to join our growing healthcare organization. This role requires strong proficiency in both hospital and outpatient clinic coding, with specialty expertise in: Cardiology Urology Dermatology General Surgery Pulmonology The ideal candidate has 2+ years of coding experience, maintains current certification (AAPC or equivalent), and consistently demonstrates accuracy, productivity, and strong clinical understanding across multiple service lines. This is a high-impact role within a performance-driven, collaborative organization focused on compliance, precision, and revenue integrity. Core Responsibilities Coding & Documentation Review Accurately assign ICD-10-CM, CPT, and HCPCS Level...

Overview Are you a current UMass Memorial Health caregiver? Apply now through Workday. Exemption Status: Non-Exempt Hiring Range: $25.83 - $43.91 Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations . Schedule Details: Monday through Friday Scheduled Hours: 7:00am-3:30pm Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 99940 - 5458 Coding Services Union: SHARE (State Healthcare and Research Employees) This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help...

GoTo Telemed seeks an exceptional  Remote Medical Biller  to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales. In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory. This...

REMOTE position Submission Requirements AAPC certificate required; MUST be CPC, CPC-H and/or COC Proficiency in AT LEAST 3 of the following: Specialty Clinics ( Med Spec Inject, Anticoag Management, Nutrition/Oncology Nutrition, Newborn/Lactation, OP Orthotic Prosth, Urology, Apheresis, Cardiac Rehab, General Surgery, Int Pain Healing, Non Inv Cardiology, Outpatient General Surgery, Proctology, Plastic Surgery, Endocrine, Benign Gyn, Infectious Disease, Neurosurgery, Oral & Facial Surgery, Ortho Total Joint, RAD CT, RAD MRI, RAD MRI, Trauma, Amputation Clinic, Burn Clinic, Dermatology, Endocrine Surgery, ENT Clinic, GI and Liver Disease, Gyn Dysplasia, Internal Medicine, Mineral Metabolism, Ortho Foot & Ankle, Pain, Burn Outpatient, Hand Surgery, Cardiology, Comprehensive Wound, Neurology, Pulmonology Clinic, Rheumatology, Eye Clinic, Access Clinic) must be able to handle HIGH Volume of cases Evaluation Management experience required Hospital...

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 a specialization in in-home health...