17 senior risk adjustment coder jobs found in Florida, NY

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

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Professional Coder II to perform ICD-9/ICD-10 coding, CPT/HCPCS abstraction, and risk adjustment activities in a remote Newark-based role. The candidate should have RHIT or AHIMA/AAPC certification and over 5 years of medical coding experience, including health insurance/chart audits or utilization review. The role emphasizes accuracy, compliance, and education of staff, with collaboration across departments and adherence to #J-18808-Ljbffr

Oscar Health, Inc. is hiring a Risk Adjustment Coder Specialist to support MA and ACA lines of business. The role reports to the Risk Adjustment Manager and emphasizes ICD-10-CM coding, CMS audit readiness, and process improvement. The position is fully remote for U.S. residents (excluding listed states) with potential travel for team meetings. Base pay varies by location and is complemented by benefits and bonuses. #J-18808-Ljbffr

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firm’s private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, worker’s compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions. The Advisory Group is currently accepting applications for an outpatient Certified Coding Auditor to work in its New York office or remotely. Principal duties and responsibilities: Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payors. Researching state...

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. About the Role The Senior Professional Coder provides services to perform code abstraction using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state and federal regulations and internal policies and procedures. HCC Risk Adjustment Coders will be involved with...

Senior Professional CoderHorizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.About the RoleThe Senior Professional Coder provides services to perform code abstraction using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state and federal regulations and internal policies and procedures. HCC Risk Adjustment Coders will be involved...

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firm’s private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, worker’s compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions. The Advisory Group is currently accepting applications for an outpatient Certified Coding Auditor to work in its New York office or remotely. Principal duties and responsibilities: Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payors....

Department/Unit: Health Information Management Work Shift: Day (United States of America) Salary Range: $64,972.00 - $97,458.00 The Senior Professional Coder will apply an advanced professional coding skill set to act as a service line coding team lead expert, working collaboratively to support all workflows related to professional fee coding/charging/denials follow-up. Coordinates with others as needed to ensure comprehensive and timely completion of professional coding processes. Audit CPT and ICD-10 diagnosis coding applied by providers and coding staff to assure compliance with federal and state regulations and insurance carrier guidelines. Provide education, instruction and training to providers and coding staff. Act as an expert for the HCC/Risk adjustment coding. This position is remote but does require onsite education to providers as needed. Essential Duties and Responsibilities Review, analyze, and validate CPT and ICD-10 diagnosis codes and charges applied by providers...

the company 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 the company community. Working at the company 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 internal...

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;...

Clinical Documentation Integrity Specialist (Coder) Remote We are growing our team and anticipate two hires starting in mid‑August and two in mid‑September. About Us Greenbrook Medical is building the new standard in primary care. We deliver high‑touch, relationship‑based care through neighborhood clinics, grounded in a simple belief: every senior deserves the kind of care we would want for our own families. Our model prioritizes time with patients, strong care coordination, and a personalized approach that improves outcomes while lowering total cost of care. We take full accountability for patient outcomes and overall cost of care, aligning clinical excellence with disciplined execution. That commitment shows up in our results, including a patient Net Promoter Score of 91, compared to 32 for typical healthcare organizations. Rooted in Tampa Bay and partnered with Tampa General Hospital, we are entering an exciting phase of growth. Backed by strong unit economics, experienced...

Lead Senior Coder QA Salary Range $65,000.00 - $75,000.00 Salary Position Type Full Time Education Level High School Overview At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact- whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. This role performs complex coding and dispute/appeal reviews, ensures compliance with RADV guidelines, provides quality assurance and feedback to coders, and serves as a subject matter expert and escalation point for coding questions. The Lead Sr. Coder also leads and supports a team of up to 15 coders, assists with training and development, and...

GoTo Telemed seeks an exceptional Remote Medical Biller to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide.As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers--with new clients and provider networks added every month as our organization scales.In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management.Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory.This position...

The Remote Professional Certified Coder is responsible for accurately coding and abstracting office, observation, inpatient, and general surgical records, including complex ambulatory and inpatient procedures across one or more specialized procedural areas. The Coder ensures complete and compliant coding of provider accounts to meet reimbursement and reporting requirements, collaborating with various departments to resolve errors and verify medical necessity and demonstrates flexibility with assignments within professional scope/duties/licensure. This position requires independent work in a fast-paced environment, with the ability to prioritize tasks as needed. The Coder must maintain a customer-focused, professional attitude and contribute to all necessary job duties within the scope of their position Essential Duties Accurate Coding & Abstraction Code and abstract office, observation, inpatient records, and surgical procedures (expertise in one or more procedural areas such...

Medical Coding Auditor Will this role be fully remote?: Yes Are there any specific locations the candidates should be in (i.e., do they need to live in IL): Any Molina approved states What is the expected schedule (include dates/time/time zone): 7-4pm or 8-5pm local time M-F. What are the day-to-day job duties?: Abstract and review inpatient and outpatient medical records for (Hierarchical Condition Categories) HCCs to determine if the HCC is supported by the medical record documentation. Knowledge of ICD-9 ICD10 Official Coding Guidelines, AHA Coding Clinic, including Codling clinic clarifications for DOS year under review. CMS RADV Medical Reviewer Guidance (1/10/2020). Top Skills Required Must have prior experience with CMS Contract Level Risk Adjustment Data Validation Audits (RADV) and HHS RADV audits and IPM audits. Must have prior vendor coding review experience. Must have the ability to complete chart review production requirements. Must be experienced in risk adjustment...

Certified Risk Coder The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do: Review medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and compliance with CMS guidelines Perform...

BigR.io seeks a Medical Coding Auditor to review inpatient and outpatient records for HCCs, ensuring documentation supports codes under CMS RADV/HHS RADV guidelines. Work is remote in the United States with a 7-4 or 8-5 local schedule Monday–Friday. Must hold CRC certification and have 5+ years of risk adjustment auditing, especially CMS/HHS RADV experience. Proficiency in ICD-10 guidelines, AHA Coding Clinic, and strong Excel skills are required; prior vendor coding review and familiarity with #J-18808-Ljbffr