218 risk adjustment coder jobs found

Risk Adjustment Coder (Project) Contract from Mid June-Late September Full Time, M-F, Day Shift Fully Remote Equipment Provided • Review inpatient and outpatient medical records to identify and validate diagnosis codes. • Abstract and assign ICD-10-CM diagnosis codes based on supporting clinical documentation. • Apply CMS risk adjustment guidelines and HCC model rules when validating coded conditions. • Confirm that documentation supports submitted diagnoses and aligns with CMS RADV audit standards. • Verify member demographic accuracy and correct beneficiary identification associated with each record. • Ensure record completeness, including the presence of all required medical record documentation and supporting materials. • Confirm submission package integrity and formatting requirements are met in accordance with RADV audit protocols. • Identify coding discrepancies, documentation deficiencies, and unsupported diagnoses. • Maintain productivity standards for high-volume chart...

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 adjustment...

REMOTE Risk Adjustment Coder (6-month contract) The Risk Adjustment Coder works in a collaborative effort directly with physicians and their office staff and other support departments to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A major focus of the position is to collect and review documents to support the organization’s quality and risk adjustment initiatives, which results in improving quality of care. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment Reviews of medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether: The diagnosis codes are supported by the documentation and ensure...

Position: Risk Adjustment Coder Location: Remote (Must reside in NY/NJ/CT) Schedule: Monday - Friday 9am-5pm Compensation: $77,506.87 - 87,195.23 annual salary **CPC, CCS, RHIT or RHIA and CRC are required** Join VillageCare as a Full Time Risk Adjustment Coder and embrace the opportunity to work remotely while making a significant impact in the Health Care sector. This role offers the flexibility of a work-from-home environment, allowing you to balance your professional and personal commitments without the daily commute. You'll be part of a dynamic team that thrives on innovation, problem-solving, and a customer-centric approach, all while contributing to the excellence and integrity that VillageCare stands for. With a competitive salary up to $77,506.87 - $87,195.23, this is not just a job but a chance to build your career in a forward-thinking organization dedicated to healthcare improvement. As a team member you'll be able to enjoy benefits such as PTO...

Elevate your career as a Senior Risk Adjustment Coder and make a meaningful impact on Medicare Advantage programs! Join a dynamic team where your expertise in HCC coding, chart review, and provider collaboration directly influences revenue integrity and audit readiness. If you excel in compliance, audit validation, and clear communication, this opportunity is designed for you. About the Job Competitive Pay: $140,000–$170,000 annually Shift Days: Regular Business Hours Shift Time: Standard Business Hours Start Date: ASAP Department: Risk Adjustment Location: California (Bay Area preferred; remote work possible for qualified CA candidates) Duration: Full-time, permanent Benefits Competitive salary and benefits package Opportunity to impact revenue and compliance Collaborative, team-focused environment Work with leading health plans and systems Flexible work arrangements for California-based candidates Continuous professional development Required Qualifications CPC and CRC...

A company is looking for a Risk Adjustment Coder to join their team. Key Responsibilities Review and abstract diagnosis information from medical records according to coding guidelines Assign appropriate ICD-10-CM codes based on provider documentation Ensure coding accuracy and completeness for risk adjustment purposes Required Qualifications, Training, and Education CPC-A certification preferred (Certified Professional Coder - Apprentice from AAPC) Strong knowledge of anatomy and physiology Familiarity with EHR systems and medical record platforms Understanding of Medicare and/or Medicaid coding guidelines Ability to work in a fast-paced, deadline-driven environment

A company is looking for a Remote Retro-Retrieval Coder. Key Responsibilities Perform code abstraction of medical records to ensure accurate ICD-10-CM code assignment Identify diagnosis and chart level impairments and opportunities for documentation improvement Maintain knowledge of coding guidelines, regulations, and assist in process improvements Required Qualifications Minimum of 3 years certified with a core coding credential from AHIMA or AAPC (CRC, CPC, CCS, CCS-P) At least 1 year of recent production coding experience in Retrospective Risk Adjustment coding 1+ years of experience working with Medicaid plans Required code set knowledge and coding experience in Medicaid, Medicare, and Commercial benefit plans Minimum of 1 year coding experience with Complete Code Capture

A company is looking for a Risk Adjustment Coder. Key Responsibilities Perform code abstraction of medical records, ensuring accurate assignment of ICD-9-CM, ICD-10-CM, CPT, and HCPCS codes Review medical records for compliance with CMS requirements and identify improvement opportunities in documentation and coding processes Maintain knowledge of coding standards and support the Medicare Risk Adjustment team in educating providers on compliance Required Qualifications, Training, and Education Minimum of three recent years of experience in HCC/Risk Adjustment and/or inpatient coding Relevant certifications such as CPC, CRC, RHIT, or RHIA from AAPC or AHIMA Strong knowledge of clinical terminology, disease processes, anatomy/physiology, and pharmacology Understanding of claims processing procedures and state and federal regulations Must reside in New York, New Jersey, or Connecticut

It's rewarding to be on a team of people that truly believe in making an impact! We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us. Job Summary The Risk Adjustment coder will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. The Risk Adjustment Coder is required to follow procedures and documentation policies regarding claim/encounter information and provide appropriate support to justify their recommendations. Duties & Responsibilities Essential Duties & Responsibilities Review medical record information to identify all appropriate coding based on CMS HCC categories Prepare the medical charts and track patient information via Excel spreadsheets. Complete...

Job Details Physician Office | Kettering | Full-Time | First Shift Responsibilities & Requirements Responsibilities & Requirements This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation.  KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee...

We are looking for experienced HCC Risk Adjustment Auditors/Coders 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 records for proper use of diagnosis and...

A healthcare provider in Knoxville is seeking a full-time Certified Medical Coder. The position requires thorough clinical documentation reviews and accurate coding of HCC diagnoses using ICD-10-CM guidelines. Candidates must have current CPC or RHIT certification, be team players with strong communication skills, and maintain HIPAA privacy. This remote role involves occasional onsite meetings, making it crucial for candidates to reside in the Knoxville area. #J-18808-Ljbffr

Join Community Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, "community" is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered - and we couldn't do it without you. Partner with Community Health Network and Deaconess Health System - IHCI The Innovative Healthcare Collaborative of Indiana LLC (IHCI) is a company formed through the partnership of Community Health Network (CHNw) and Deaconess Health System (DHS). Both CHNw and DHS place high importance on continuing and advancing population health and value-based care to improve patient health...

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the...

IKS Health is hiring HCC Coders About IKS Health: www.ikshealth.com IKS Health’s goal is to enable the efficient delivery of high-quality care through a combination of leading-edge technology and human expertise. The IKS Care Enablement Platform enables us to deliver the chores of healthcare, across administrative, clinical, and operational burdens by utilizing. tech-enabled clinical documentation, medical coding, and revenue integrity solutions for healthcare. We’re redefining the future of Care Enablement and creating transformative value in healthcare. Job Description: HCC Coder must hold one of the following Credentials - CPC, COC, CRC, CCS, RHIT, or RHIA Reviews medical records to identify pertinent HCC codes relative to the patient's health care encounter. Abstracts appropriate information from the medical record based on the guidelines provided by the client and after a thorough review of the medical record. Consistently meet productivity and quality...

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the...

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be...

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the largest...

Drive Accuracy. Influence Outcomes. Protect Revenue. We are seeking a Senior Risk Adjustment Coder (HCC / Medicare Advantage) to play a critical role in risk adjustment accuracy, audit readiness, and clinical documentation excellence. Job Title: Senior Risk Adjustment Coder Location: California (Candidates must be currently based in CA – Hybrid work model;) Employment Type: Full-Time (Direct Hire) Salary Range: $91,000 – $119,000 annually, based on experience, skills, and internal equity About the Role: We are seeking an experienced Senior Risk Adjustment Coder to support a leading healthcare organization focused on accurate risk adjustment, compliance, and documentation excellence. This role is critical in ensuring accurate HCC capture, audit readiness, and high-quality clinical documentation, directly impacting reimbursement accuracy and regulatory compliance. Key Responsibilities: Perform risk adjustment coding and chart abstraction in alignment with...

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura’s Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura’s health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the largest...

A consulting company is searching for a Sr. Associate with expertise in coding, revenue cycle, and clinical operations. This role focuses on complex investigations, compliance evaluation, and project management within healthcare disputes. The ideal candidate must be CRC certified with a strong grasp of clinical terminology and health regulations. Excellent communication skills and proficiency in Excel, Word, and PowerPoint are essential. The position offers a salary range from $85,000 to $200,000, depending on experience and location. #J-18808-Ljbffr

A healthcare company seeks a Risk Adjustment Coding Specialist II in Orange, CA. The role involves reviewing medical records, educating providers, and performing coding audits. Candidates must have strong coding skills and certifications, along with 3-5 years of risk adjustment experience. This position requires up to 75% travel to provider offices and follows a hybrid work structure, allowing flexibility in work location. Competitive pay ranges from $70,000 to $85,000 per year. #J-18808-Ljbffr

A health care advisory firm is seeking a Sr. Associate to analyze medical records and ensure compliance with coding standards. The ideal candidate will be certified in Risk Adjustment Coding and have at least five years of experience in HCC/Risk Adjustment methodologies. Strong communication skills and proficiency in Excel are essential. This role offers a hybrid work environment. Salary range is between $85,000 to $200,000 based on qualifications and experience. #J-18808-Ljbffr

Ankura is a team of excellence founded on innovation and growth.**Practice Overview:**Ankura’s Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura’s health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the...