52 risk adjustment coder ii jobs found

Job Number: 180041, Job Title: Risk Adjustment Coder II, Salary: $27.69 - $34.62 JOB SUMMARY The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a subject matter expert for risk adjustment and will assist in the development of team trainings, quality assurance audits, and collaborating with multiple departments across the organization. JOB SPECIFICATIONS AND CORE COMPETENCIES Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions,...

Community Health Choice, Inc. seeks a Risk Adjustment Coder II in Houston, Texas. The role involves advanced medical record reviews and coding of chronic conditions to ensure correct risk scoring, complying with CMS guidelines and internal policies. The ideal candidate has a Bachelor's degree or equivalent experience, and AHIMA/AAPC certification, along with 3-5 years of experience in risk adjustment coding. Join a team dedicated to improving healthcare quality for over 400,000 members. #J-18808-Ljbffr

Company Overview 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...

Job Summary The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a subject matter expert for risk adjustment and will assist in the development of team trainings, quality assurance audits, and collaborate with multiple departments across the organization. Responsibilities Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions, utilizing ICD-10 coding guidelines for Commercial and Medicare risk adjustment programs. Conduct thorough...

340B Health is seeking a Risk Adjustment Coder II to provide advanced support for medical record reviews and ensure accurate capture of chronic conditions. This role involves coding according to CMS guidelines and improving documentation standards. The ideal candidate will have a Bachelor's Degree or equivalent experience and be an AHIMA/AAPC Certified Coder with 3-5 years of relevant coding experience. Strong analytical and interpersonal skills are essential. This position supports Medicare and Commercial Risk Adjustment programs. #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,...

Direct Jobs is seeking a Risk Adjustment Coder II in Houston, Texas. This role involves advanced support for medical record reviews, ensuring correct capture of chronic conditions and compliance with CMS guidelines. The Coder II acts as a subject matter expert, facilitating team training and audits. The ideal candidate will have a Bachelor's degree or equivalent experience in risk adjustment, along with relevant coding certifications. Experience in Commercial and Medicare coding is required alongside strong analytical and communication skills. #J-18808-Ljbffr

St Luke's Health is looking for a Value Based Coder II in Houston, Texas. This role involves reviewing patient medical records to enhance coding opportunities with a strong emphasis on Hierarchical Condition Categories (HCC). The ideal candidate will have 2+ years in outpatient coding and a deep understanding of risk adjustment principles. Responsibilities include providing education to network providers and ensuring compliance with coding guidelines. #J-18808-Ljbffr

A leading healthcare provider in Texas is seeking an experienced Value Based Coder II to review medical records for coding opportunities, focusing on Hierarchical Condition Categories (HCC). The role involves developing provider education and ensuring compliance with coding guidelines. Candidates should have a Bachelor's degree in healthcare or equivalent experience, CPC/CCS/CRC certification, and at least 2 years of outpatient coding experience. Competitive hourly pay ranges from $25.30 to $35.74. #J-18808-Ljbffr

Community Health Choice is looking for a Risk Adjustment Coder II to manage complex medical record reviews to ensure accurate patient risk score captures. The role requires expertise in mapping conditions to HCCs in compliance with CMS guidelines. Key responsibilities include providing advanced coding reviews, conducting documentation assessments, and contributing to departmental goals and quality standards. Candidates should have at least 3-5 years of experience in risk adjustment coding. #J-18808-Ljbffr

Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II for Orange County. This role focuses on chart reviews to identify coding gaps and drive accuracy for Medicare Advantage, ACA, and commercial plans. You will educate providers, track KPIs like HCC recapture and AWVs, and work up to 75% travel to provider offices in Orange County. AAPC/AHIMA certification and 3+ years of risk adjustment experience are preferred. #J-18808-Ljbffr

Humana is seeking a Medical Coder / Coding Educator II to identify opportunities to improve provider documentation and design tailored education plans. You will report to the Manager, Medicare Risk Adjustment, and coordinate on-site sessions, data-driven reports, and cross-functional collaboration. You will develop educational materials from audit results, use data visualization tools, and deliver presentations to leadership and providers while traveling up to 5% to surrounding offices. #J-18808-Ljbffr

Medical Coding Specialist I/II - Profee Pediatrics/Multi Specialty Be part of something remarkable Join the #1 hospital in Wisconsin! We are seeking a Medical Coding Specialist I/II to: 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 Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers. Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as appropriate. Qualifications High School Diploma or equivalent and medical coding education Required or...

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...

Medical Coder Multi-Specialty (Hospital & Clinic) Location: Kingwood or Remote 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...

Humana is seeking a Medical Coder / Coding Educator II to identify opportunities to improve provider documentation and tailor an education plan for each assigned provider. Reports to the Manager, Medicare Risk Adjustment. The role involves arranging sessions, analyzing coding quality, presenting findings with data visualization, and delivering on‑site education with up to 5% travel. The ideal candidate holds CPC certification, 3+ years' experience in coding education or auditing, and proficiency #J-18808-Ljbffr

Job Title Job Description Submission Requirements AAPC certificate required; MUST be CPC, CPC-H and/or COC - REQUIRED Must have graduated from an approved coding program or health information management program - REQUIRED 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...

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...

Medical Coding Specialist II - HB Fiscal Coder This is a full-time, 1.0 FTE position that is 100% remote. Hours may vary based on the operational needs of the department. Applicants hired into this position can work 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. Join the #1 hospital in Wisconsin! We are seeking a Medical Coding Specialist II - HB Fiscal Coder to: 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...

The University of Wisconsin Medical Foundation in Madison seeks a full-time Medical Coding Specialist II. This remote position involves utilizing coding resources such as ICD-10-CM and CPT codes. Candidates should have at least one year of coding experience and an active coding certification upon hire. The role offers a substantial benefits package including health insurance, retirement plans, and options for flexible schedules. Join us in a culture that values equal employment opportunities and fosters belonging. #J-18808-Ljbffr

Value Based Coder II Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings. The posted compensation range of $25.30 - $35.74 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law. Job Summary and Responsibilities The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently...

Medical Coder II Status: Part Time(20 hours/week) | Non- Exempt Reports to: Health Information and Technology Manager A. Purpose and Scope of Position Responsible for reviewing and interpreting medical records, documents, and other patient data to assign appropriate codes for healthcare procedures, diagnoses, and services provided. These codes are used for insurance reimbursement, statistical purposes, and maintaining accurate patient records. Medical coders work closely with healthcare providers, insurance companies, and billing departments. B. Job Requirements 1. Required Qualifications • Education: High school diploma or equivalent. • Certification: Certification from a recognized body such as the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or equivalent (e.g., CPC, CCS, or CCA). • Experience: 3+ years of relevant coding experience 2. Preferred Qualifications • Associate's degree in...

Medical Coding Specialist II - Orthopedics Outpatient, Multi Specialty Middleton, WI, United States (Remote) Job Description Work Schedule: This is a full-time, 1.0 FTE position that is 100% remote. Shifts will be flexible and will be discussed during the interview. Hours may vary based on the operational needs of the department. Applicants hired into this position can work 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’re included a link below to view the full list of approved remote work states. We are seeking a Medical Coding Specialist II to: 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...

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, 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 experience strongly desired due...