288 risk adjustment coder jobs found

KPN Pro Fee Coding Specialist This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. 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 coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] Demonstrate initiative for maintaining current knowledge of...

Senior Risk Adjustment Coder 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 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...

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...

HCC Risk Adjustment Auditor/Coder, Sr. 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 procedure codes. Interface effectively with physicians and office...

Risk Adjustment Coder 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 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 appropriate...

Medical Records Coder Position Purpose: Codes, abstracts and analyzes inpatient and/or outpatient medical records using the most current International Classification of Diseases, Ninth Revision (ICD-9) for CMS risk adjustment purposes. Education/Experience: Required a high school or GED. Preferred a bachelor's degree in a related field. Candidate experience: Required.

HCC-Risk Adjustment Coder - Remote Job Category: Coder Requisition Number: REMOT001685 Full-Time Remote Virtual, USA +1 more locations Job Details Description IKS Health is hiring HCC Coders 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...

University HealthCare Alliance (dba Stanford Medicine Partners) is the medical foundation of Stanford Health Care and Stanford Medicine. Stanford Medicine Partners was born out of the aspiration for Stanford Medicine and local, leading providers to partner together to bring high-quality care to patients within surrounding communities. Together, we are committed to delivering outstanding, leading-edge care to our patients. How We Work With Stanford Health Care Anchored by Stanford Health Care and the Stanford School of Medicine, Stanford Medicine Partners is dedicated to providing the highest standards of clinical excellence in order to ensure access for Bay Area patients to leading providers, while contributing to Stanford University’s well-respected Stanford Hospital and Clinics’ transformation into a broader and more integrated regional health system. Together, SMP and Stanford are pioneering new ways to practice medicine across multiple locations, using Stanford’s advanced...

Job Summary and Responsibilities As a Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. 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. Ensure that the diagnosis codes for each chronic or...

A healthcare organization is seeking a Coder to translate medical records into standardized codes and improve clinical documentation. This remote position requires an Associates degree and coding certifications. Key responsibilities include ensuring compliance with guidelines, educating providers, and safeguarding confidentiality of health information. Candidates should have expertise in CPT and ICD-10 coding and strong communication skills. A competitive pay range is offered alongside comprehensive benefits. #J-18808-Ljbffr

A healthcare organization is seeking a full-time Certified Medical Coder based in Knoxville, TN. This remote role involves detailed clinical documentation reviews and accurate coding of HCC diagnoses. Candidates must have current CPC or RHIT certification and ideally two years of experience in an ambulatory care setting. Responsibilities include collaborating with healthcare providers, maintaining HIPAA guidelines, and educating staff on coding practices. The position is ideal for organized team players with strong communication skills. #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...

A leading consulting firm seeks a Sr. Associate to join its Health Care team in Washington, D.C. This position involves coding, compliance analysis, and project management for investigations and disputes in the health care sector. Ideal candidates will possess strong clinical knowledge and a CRC certification, with at least five years of relevant experience. The role allows for remote work and requires excellent communication skills. Salary range is between $85,000 and $200,000, commensurate with experience and other factors. #J-18808-Ljbffr

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...

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...

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...

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...

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

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 community-based healthcare organization is looking for a Full Time Risk Adjustment Coder, offering a remote work option for residents of NY/NJ/CT. The role requires strong coding skills with a focus on ICD and CPT codes, ensuring compliance with regulations. Applicants must have relevant certifications and a commitment to healthcare quality improvement, with a competitive salary ranging from $77,506.87 to $87,195.23 annually. Employees enjoy various benefits including paid time off and education reimbursement. #J-18808-Ljbffr

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

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...