469 risk adjustment jobs found

Description COMPANY OVERVIEW Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com. SUMMARY DESCRIPTION The Senior Risk Adjustment Coding Auditor is a highly experienced coding professional responsible for ensuring compliant, accurate, and high-quality risk adjustment coding across Medicare Advantage programs. This role is critical to...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you’re stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical role in translating clinical documentation...

Datavant is seeking a remote HCC coder to review medical records, identify, and code diagnoses using ICD-10 guidelines for risk adjustment and reimbursement. You will ensure accuracy and compliance while working in a fast-paced production environment. The role requires at least 2 years of HCC coding experience, AHIMA/AAPC credentials, and the ability to manage multiple client projects remotely. Expect a 40-hour work week with competitive base pay. #J-18808-Ljbffr

Cano Health is seeking an ACO Coding Auditor to review medical records and ensure Medicare Risk Adjustment codes are captured accurately for CMS and Commercial ACOs. You will act as a consultant to practices, driving quality improvements and compliance across coding procedures. The role requires on-site and remote audits, with travel to clinics as needed. The ideal candidate has CPC/CRC/CCS-P/CCS-H/RHIT certification and 3+ years in Medicare Risk Adjustment, plus strong ICD-10/CPT expertise. #J-18808-Ljbffr

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...

Millennium Physician Group is seeking a Risk Adjustment Coding Specialist II to translate patient encounters into ICD-10-CM codes for claims processing. The role emphasizes accuracy, compliance with ICD-10-CM guidelines, and collaboration within the MRA Department for concurrent outpatient coding. The candidate will abstract and assign codes supported by documentation, identify missing information, and communicate with providers when documentation is unclear or incomplete. #J-18808-Ljbffr

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Remote Risk Adjustment Compliance Auditor is to conduct provider and coder level reviews and audits to ensure accurate risk adjustment data is being submitted to the CMS. Develops and maintains tracking tools, reviews and audits outcomes / findings and monitors any corrective active plans implemented due to review or audit findings. Monitors...

Astrana Health is seeking a Risk Adjustment Coding Specialist to support Orange County operations. You will conduct high-volume chart reviews to identify coding gaps, then translate findings into education for providers and practice leaders, driving HCC recapture and KPI improvements. olla You will travel to provider offices up to 75% and collaborate with IPA teams, offering auditing and education to ensure CMS, Medicare and payer guidelines are met while staying current on ICD-10/HCC updates. #J-18808-Ljbffr

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.The Remote Risk Adjustment Compliance Auditor is to conduct provider and coder level reviews and audits to ensure accurate risk adjustment data is being submitted to the CMS. Develops and maintains tracking tools, reviews and audits outcomes / findings and monitors any corrective active plans implemented due to review or audit findings. Monitors...

CW Risk Adjustment Coder Experienced Risk Adjustment Coder with a strong background in Medicare Advantage Risk Adjustment coding and ACA Risk Adjustment coding. This position supports ongoing risk adjustment initiatives through accurate coding, medical record review, documentation validation, and quality assurance activities. The coder will help ensure compliance with CMS and other regulatory requirements while supporting the organization's risk adjustment accuracy and revenue integrity goals. Candidates should have demonstrated experience with CMS-HCC coding methodologies, medical record review, and risk adjustment documentation validation. This position works under general supervision and does not have direct supervisory responsibilities. Key Responsibilities: Review and assess medical record documentation and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs. Perform retrospective and prospective coding reviews to identify...

Prominence Health seeks a skilled Coder of Risk Adjustment to ensure accurate, compliant coding and documentation review supporting Medicare risk adjustment and organizational compliance. The coder performs post-review production coding, medical record abstraction for HEDIS data, and chart preparation for scheduled health assessments, guiding coding requirements for provider reviews. This is an onsite position. Knowledge of HEDIS data collection is required. #J-18808-Ljbffr

CW Risk Adjustment Coder Position Summary Experienced Risk Adjustment Coder with a strong background in Medicare Advantage Risk Adjustment coding and ACA Risk Adjustment coding. This position supports ongoing risk adjustment initiatives through accurate coding, medical record review, documentation validation, and quality assurance activities. The coder will help ensure compliance with CMS and other regulatory requirements while supporting the organization's risk adjustment accuracy and revenue integrity goals. Candidates should have demonstrated experience with CMS-HCC coding methodologies, medical record review, and risk adjustment documentation validation. This position works under general supervision and does not have direct supervisory responsibilities. Key Responsibilities: Review and assess medical record documentation and accurately assign ICD-10-CM diagnosis codes for Medicare Advantage and ACA Risk Adjustment programs. Perform retrospective and prospective coding...

Practice Resources LLC, a multi-specialty practice management company, seeks an experienced Risk Adjustment Medical Coder for a fully remote role. You will validate CPT/diagnosis codes, code for HCCs, and ensure CMS guidelines are met. Ideal candidates hold CCS/CPC, CRC is a plus, with HIPAA compliance, EHR familiarity, and strong communication. We offer flex weeks after training and access to coding resources. #J-18808-Ljbffr

HealthPartners is seeking a Senior Risk Adjustment Coding Analyst to lead retrospective chart reviews for diagnosis coding accuracy and to ensure accurate representation of population risk for plan performance. The role includes reviewing vendor coding, delivering education to providers, supporting CMS data validation, and driving process improvements across the risk adjustment workflow while protecting patient information and complying with regulations. #J-18808-Ljbffr

Job Description HealthPartners is hiring a Risk Adjustment Coding Analyst Senior. This position is responsible for diagnosis coding review and vendor coding quality assurance; working to ensure that plan performance and plan revenue is based on an accurate representation of our population's care needs and risks. ACCOUNTABILITIES: Performs retrospective chart review for diagnosis coding accuracy. Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and deliver provider education. Reviews vendor coding and provides recurring feedback and education to vendor team. Participates in internal and CMS-mandated risk adjustment data validation review. Identifies, documents, and messages process improvements, clinical documentation improvements and/or other educational opportunities. Develops and performs training and educational seminars to physicians and advanced practice providers on risk adjustment topics. Increases collaborative...

Hybrid | Des Moines, IA (Onsite Tues–Thurs, Remote Mon/Fri) $40/hour | 6-Month Contract with Potential for Conversion We are seeking a Certified Risk Adjustment Coder (CRC) to support Medicare Risk Adjustment initiatives through detailed HCC medical record reviews and direct provider engagement. This role is ideal for someone confident, collaborative, and comfortable working onsite with provider teams to drive documentation accuracy and performance improvement. This position requires onsite presence Tuesday–Thursday in Des Moines, IA with 10% local travel , and remote flexibility on Mondays and Fridays. Position Overview This role performs concurrent medical record reviews to ensure accurate capture of HCC conditions and appropriate documentation reflecting patient severity of illness. The coder will collaborate closely with physicians, clinical leadership, and provider engagement teams to improve documentation practices and support compliance with CMS guidelines. Key...

Saint Alphonsus Health System in Boise, Idaho, is seeking a full-time Risk Adjustment Coding Specialist to join the Population Health team. This day-shift role offers a work-from-home option after training. You will develop educational materials and lead coding and documentation education with providers and staff. Ideal candidates have 2 years in medical practice or centralized billing, and must obtain AAPC/AHIMA credentials within 1 year. #J-18808-Ljbffr

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you’re stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical role in translating clinical documentation...

Practice Resources LLC, a multi-specialty practice management company, is looking for an experienced Risk Adjustment Medical Coder.This is a fully remote position. The pay range for this position is $18.00-$30.00 per hour. Job Description: Apply in-depth knowledge of coding principles to validate missing, incomplete, or incorrect CPT and diagnosis codes, abstracts, or sequences Code chronic disease that meets HCC and Risk Adjustment criteria Assign diagnosis and procedures codes according to CMS HCC and all CPT and ICD 9 and 10 guidelines. Validate missed coding opportunities Demonstrate advanced knowledge of medical terminology, anatomy, and physiology Communicate with physicians about documentation and coding Reliability and a commitment to meeting tight deadlines on all assigned charts Knowledge of HIPAA recognizing a commitment to privacy, security, and confidentiality of all medical charts. Benefits: AAPC/AHIMA membership fees covered Subscription...

## Medicare Risk Adjustment Compliance Auditor (CPC, CCS, or CCS-P Required) (Remote)Apply: Fully Remote: Anywhere in the U.S.: Full time: Posted Yesterday: End Date: October 16, 2026 (20 days left to apply): R2578Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.The Remote Risk Adjustment Compliance Auditor is to conduct provider and coder level reviews and audits to ensure accurate...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Remote Risk Adjustment Compliance Auditor is to conduct provider and coder level reviews and audits to ensure accurate risk adjustment data is being submitted to the CMS. Develops and maintains tracking tools, reviews and audits outcomes / findings and monitors any corrective active plans implemented due to review or audit findings. Monitors...

Job Description Job Description Primary Purpose: Support the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures in Risk Adjustment, CMS 5 Star, and the commercial and Medi-Cal programs. Principal Duties and Responsibilities (* = essential functions): Outreach and coordinate care for IPA members who need preventative and/or chronic care services such as mammograms, colonoscopies, uncontrolled HbA1c, uncontrolled blood pressure, etc. Collaborate with Risk Adjustment and quality on provider education. Maintain knowledge of clinical initiatives and risk adjustment program requirements  Maintain knowledge of 5 Star performance and risk adjustment factors for all IPAs. Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports. Coordinate outreach to PCP offices on member due reports, including the No Annual Visits list. Provide PCP offices with ongoing...

Risk Adjustment Coder Location: Virginia Beach, VA Work Shift: First (Days) Overview: Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA! Hours: Monday - Friday, 8:00AM -5:00PM, dayshift. This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week. The role also includes travel as needed to support business objectives and team collaboration. Responsibilities: Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS...