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Certified Risk Adjustment Coder Jobs in Rhode Island

Crete United

Electrical Service Tech

Smithfield, RI · On-site

$37 - $45/hr

... for adjustment or repair, and to ensure compliance with codes. * Advise management on whether ... OSHA 10 certificate, or willingness to complete it * Journeyman electrician license from RI is a ...

Amazon

Onsite Medical Representative

Johnston, RI · On-site

$38K - $43K/yr

You will refer care to outside medical providers as needed, and learn about OSHA regulations, risk ... OR - Current Active Athletic Trainer Certification by either the Board of Certification (BOC) or ...

Cushman & Wakefield

Operating Engineer

Providence, RI

$70K - $94K/yr

... adjustments and installations about the property • Perform repairs to plumbing fixtures (water ... Journeyman or Master Electrician License or City Licenses, such as Refrigeration Certificate of ...

Citizens

Manager Application Security

Johnston, RI · On-site +1

$133K - $190K/yr

... risk objectives Establish and enforce application security standards, secure coding practices, and ... Certifications Bachelor's degree in Computer Science, Cybersecurity, Information Systems, or a ...

Citizens Bank

Manager Application Security

Johnston, RI · On-site

$133K - $190K/yr

... and risk objectives • Establish and enforce application security standards, secure coding ... maturity models Education and Certifications • Bachelor's degree in Computer Science ...

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All JobsCertified Risk Adjustment Coder JobsCertified Risk Adjustment Coder Jobs in Rhode Island

Certified Risk Adjustment Coder information

See Rhode Island salary details

$16

$28

$69

How much do certified risk adjustment coder jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for certified risk adjustment coder in Rhode Island is $28.68, according to ZipRecruiter salary data. Most workers in this role earn between $21.44 and $28.46 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Certified Risk Adjustment Coder, and why are they important?

To thrive as a Certified Risk Adjustment Coder, you need expertise in medical coding, a thorough understanding of ICD-10-CM guidelines, and certification such as CRC (Certified Risk Adjustment Coder). Familiarity with coding software, electronic health records (EHRs), and risk adjustment models like HCC is typically required. Attention to detail, analytical thinking, and strong communication skills help ensure accurate code assignment and effective collaboration with healthcare providers. These skills and qualifications are crucial for capturing precise patient data, which directly impacts healthcare reimbursement and compliance.

What is a Certified Risk Adjustment Coder?

A Certified Risk Adjustment Coder is a professional who specializes in reviewing and coding medical records to ensure accurate documentation of diagnoses for risk adjustment purposes. These coders play a crucial role in healthcare reimbursement, especially for Medicare Advantage and other risk-adjusted health plans. They analyze patient records using ICD-10-CM codes to help healthcare organizations receive appropriate compensation based on the severity of patient conditions. Certified Risk Adjustment Coders typically hold certifications such as the CRC from the AAPC, demonstrating their expertise in this specialized field.

What are some common challenges Certified Risk Adjustment Coders face, and how can they overcome them?

Certified Risk Adjustment Coders often encounter challenges such as staying current with evolving coding guidelines and accurately interpreting complex medical records. To overcome these difficulties, coders should regularly participate in ongoing education, leverage resources from professional organizations, and collaborate closely with providers to clarify documentation. Maintaining a strong attention to detail and utilizing coding software tools can also help minimize errors and improve coding accuracy. Engaging in peer reviews within the team can further enhance consistency and knowledge sharing.

What is the difference between Certified Risk Adjustment Coder vs Certified Medical Coder?

AspectCertified Risk Adjustment CoderCertified Medical Coder
CertificationsRequires risk adjustment-specific credentials like RAC, CRC, or CPC-RRequires CPC or CCS certifications
Work EnvironmentPrimarily in health insurance, risk adjustment, and payer settingsHospitals, clinics, physician offices, and outpatient facilities
Industry UsageUsed mainly in health insurance and risk adjustment programsUsed across healthcare providers for medical coding and billing

The Certified Risk Adjustment Coder specializes in coding for risk adjustment programs within health insurance, focusing on accurate documentation for reimbursement. In contrast, the Certified Medical Coder works across various healthcare settings, primarily coding diagnoses and procedures for billing. While both roles require coding certifications, their focus areas and work environments differ significantly.

What are popular job titles related to Certified Risk Adjustment Coder jobs in Rhode Island? For Certified Risk Adjustment Coder jobs in Rhode Island, the most frequently searched job titles are:
What job categories do people searching Certified Risk Adjustment Coder jobs in Rhode Island look for? The top searched job categories for Certified Risk Adjustment Coder jobs in Rhode Island are:
Certified Risk Adjustment Coder jobs near you
Infographic showing various Certified Risk Adjustment Coder job openings in Rhode Island as of July 2026, with employment types broken down into 1% As Needed, 74% Full Time, 18% Part Time, and 7% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $59,659 per year, or $28.7 per hour.
Claim Auditor Payment Integrity (44544)

Claim Auditor Payment Integrity (44544)

Neighborhood Health Plan of Rhode Island

Smithfield, RI • On-site

Full-time

Posted 28 days ago

Job description

The Claim Auditor in Payment Integrity will address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters. Claim payment accuracy will be recognized through sound audit review methods and practices, including but not limited to; claim payment evaluation, medical chart review, claim payment data analysis and assessment of established organizational contractual parameters. Independently analyzes, extracts, refines, and interprets claims data for actionable insights. The Auditor uses self-directed, decision making and problem solving that directly impacts financial outcomes and results.
Duties and Responsibilities:
Responsibilities include, but are not limited to:
  • Investigate potential over-utilization by performing audits thought pre and post claim payment.
  • Initiate and verify claims adjustments, maintain audit documentation, and prepare savings reports.
  • Identify new audit areas through data mining and performing sample audits.
  • Develops reports and deliverables for management and communicates with all levels of stakeholders.
  • Provide recommendations and collaborate with Payment Integrity team on audit outcomes, identified issues, recommended modifications to clinical medical policies, billing and reimbursement guidelines, and online provider manual.
  • Serve as contact with all operational areas relevant to Payment Integrity audit decisions.
  • Represent company in internal and external meetings/conference calls when needed to discuss audit results or perform coding education.
  • Performs other duties as assigned

Qualifications
Required:
  • Associate's degree or equivalent three (3) years of claim review work experience to equate to the degree
  • American Academy of Professional Coder's (AAPC) CPC certification or similar experience in medical records review, claims processing or utilization/case management in clinical practice or managed care organization
  • Fundamental knowledge of Medicare/Medicaid Guidelines
  • Experience with provider payment methodologies
  • Critical thinking and judgment/decision making skills
  • Solutions oriented-positive attitude
  • Independent problem solving-innovative thinker
  • Strong communication skills (written/verbal)
  • Excellent Customer Service skills
  • Ability to effectively prioritize and execute tasks in a high-pressure environment
  • Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
  • Ability to work independently as well as part of a team

Preferred:
  • American Academy of Professional Coder's (AAPC) COC and/or CIC
  • Data analytics experience
  • Knowledge of COGNOS reporting environment

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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