786 risk adjustment jobs found

Job Description Job Description Overview This is a temporary position for approximately 6 months. Responsibilities The Risk Adjustment Coder is responsible for providing support to the Risk Adjustment Department. This position will work closely with the VBC Risk Director, Program Managers, (Nurse Practitoners) NPs and external vendors to assist with managing the Chronic Disease Managed Visit (CDMV) Program through coding charts and queries.     Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.   Collaborate with Lead Coder to review CDMV progress notes and CDMV Summary Continuous streamlined communication with NPs on queries as needed Weekly meeting with Lead coder to discuss any barriers on receiving responses to queries or any questions regarding coding Stay up to dates with CMS Coding Guidelines as identified for Risk Adjustment (CPT and ICD codes) Collaborate with coordinators and specialists for adhoc...

Risk Adjustment CoderPorter 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 OverviewWe are seeking a certified coder with expertise in risk adjustment coding and a specialization in in-home...

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...

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...

Clinical Risk Adjustment Coder Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines. Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models. Conduct in-home or virtual health assessments with patients, evaluating and...

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...

Risk Adjustment Coder Job Summary We are seeking an experienced and certified Risk Adjustment Coder to perform medical record reviews, coding validation, and audit activities in accordance with applicable CMS guidelines. The ideal candidate will have strong knowledge of ICD-10-CM coding, risk adjustment methodologies, medical record documentation, and regulatory compliance requirements. Key Responsibilities Review medical records to identify and validate reportable diagnoses. Perform first-pass and second-pass coding reviews and audits, as applicable. Ensure accurate diagnosis code assignment in accordance with ICD-10-CM guidelines and CMS requirements. Verify that coded diagnoses are supported by appropriate medical record documentation. Identify coding discrepancies, documentation gaps, and potential compliance issues. Maintain accurate audit documentation and record findings, errors, and recommendations. Follow established coding guidelines, quality standards, and...

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...

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 education on quality measures Work with health...

Job Description Job Description Role type: Risk Adjustment Coding Auditor Quantity of resources: 2 Duration: 6 months JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required skillset: MS Suite CPC certified CRC certified 5 years of risk adjustment experience

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment team. 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 position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana;...

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...

Description *Hybrid Role, must be located in State of Colorado* Join Carina Health Network and help us make Colorado communities healthier! Are you passionate about population health and interested in improving patient experience and outcomes? If so, we support several community health organizations (CHO), and this company is for you! At Carina Health Network, we are transforming community health by delivering proactive, data-informed, and whole-person care that drives measurable impact. Our work helps people stay healthier longer, by supporting community health organizations who have patients with chronic conditions like diabetes and high blood pressure, ensuring regular check-ups for older adults, and identifying mental health needs early. We help community health organizations prevent costly ER visits by connecting people with the right care at the right time. Through our value-based care programs, we empower frontline care teams to improve outcomes while earning fair,...

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...

Clinical Risk Adjustment Coder Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible. The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines. Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models. Conduct in-home or virtual health assessments with patients, evaluating and...

GeBBS Consulting is a healthcare technology professional services and consulting firm based in Towson, Maryland servicing clients throughout the US. We are celebrating our 28th year in business. We have two divisions: 1) Hospital / Provider Practice 2) Managed Care / Payer Practice – we work directly with health plans (very strong in the Blue Cross Blue Shield space). GeBBS Consulting has over two decades of experience supporting healthcare clients throughout the US. Summary One of our New York-based health plan partners is seeking a Risk Adjustment Coder to support the validation of health risk factors identified through prior coding activities. The ideal candidate will have ACA RADV coding experience, strong Excel skills, and a proven ability to review medical records, validate diagnoses, and ensure documentation meets risk adjustment and compliance standards. Required Skilled Minimum 3 Years of experience as a Medical Coder. Prior experience with ACA RADV coding. Strong...

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...

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...

RELI Group seeks a detail-oriented Medical Coder to support Risk Adjustment and Medicare Part C audits by accurately coding inpatient, outpatient, and physician office records. The ideal candidate is certified (CPC/CCS/RHIA/RHIT) with ICD-9-CM/ICD-10-CM proficiency, at least 1 year of experience, and the ability to maintain high accuracy and confidentiality in a fast-paced environment. Excellent benefits and HUBZone-friendly opportunities are noted; competitive compensation aligns with #J-18808-Ljbffr

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder to perform code abstraction using ICD-9-CM/ICD-10-CM guidelines, AHA guidance, and regulatory rules. You will support risk adjustment coding initiatives, ensuring high accuracy and compliance across commercial and Medicare programs. You will educate staff, develop QA processes, and collaborate with cross-functional teams to improve coding quality, documentation, and performance, while advancing risk adjustment #J-18808-Ljbffr

Title: Risk Adjustment Coding Auditor Location: Remote Job Type: Contract (6 months) Compensation: $35.00 – $38.00 per hour Industry: Health Insurance About the Role Our firm is partnering with a leading nonprofit health insurance organization that serves members across commercial, Medicare, and Medicaid health plans. We are seeking an experienced Risk Adjustment Coding Auditor to help ensure the accuracy, integrity, and compliance of clinical coding and documentation used in risk adjustment programs. In this role, you will support accurate reimbursement and regulatory compliance by conducting detailed coding audits, identifying documentation gaps, and providing expert guidance on risk adjustment coding practices. This position is ideal for a coding professional with strong HCC auditing experience who is passionate about data accuracy, compliance, and continuous improvement. Job Description As a Risk Adjustment Coding Auditor, you will evaluate coded clinical data to ensure...

Risk Adjustment Coder 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...

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...