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Entry Level Risk Adjustment Coder Jobs in Missouri

Mercy

$95K - $113K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... reduce risk. * Assess treatment effectiveness and recommend therapeutic adjustments. * Provide ... Adhere to organizational dress code, hygiene, and PPE standards. * Maintain all required licensure ...

SPX

Stockroom Specialist

Cuba, MO · On-site

  • Medical

  • Retirement

  • PTO

Marks identifying codes, figures, or letters on articles. * Distributes stock among production ... Makes adjustments or repairs to articles carried in stock. * Cuts stock to size to fill order.

St. Louis Metropolitan Police Department

Be Seen First

Deputy Marshal

Saint Louis, MO · On-site

$35K - $48K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... rapid adjustment on equipment, machinery and tools such as motor vehicle, firearm, personal ... Tasks may risk exposure to adverse environmental conditions, such as dirt, dust, pollen, wetness ...

CCL Label, Inc.

Rewind Machine Operator

Saint Charles, MO · On-site

$16.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Operate rewind machinery by depressing color-coded buttons to start and stop rewind process ... Make label adjustments and/or replacements accordingly. * Inspect back-numbered labels for proper ...

True Media

Marketing Project Manager

Columbia, MO · Hybrid

... risk. * Monitor account activity against the statement of work and alerts the internal team about ... Facilitate discussions and adjustments concerning time allocations with team members as needed.

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Entry Level Risk Adjustment Coder information

What is an entry level risk adjustment coder?

An Entry Level Risk Adjustment Coder reviews medical records to identify and assign accurate diagnosis codes for risk adjustment purposes. Their work ensures healthcare organizations receive appropriate reimbursement based on patient health conditions. They typically use ICD-10-CM codes and follow guidelines from CMS and other regulatory bodies. This role requires strong attention to detail, knowledge of medical terminology, and an understanding of risk adjustment models. Entry-level coders may work in various healthcare settings, including insurance companies, hospitals, or coding firms.

What does an entry level risk adjustment coder do?

A typical day for an entry level risk adjustment coder involves reviewing patient medical records to identify and assign appropriate diagnostic codes based on clinical documentation. You’ll use specialized coding software and electronic health record systems to ensure accuracy and compliance with federal guidelines. Collaboration with senior coders, team leads, and occasionally clinicians is common when clarification or additional documentation is needed. Most entry level coders work in an office or remote environment and spend much of their day analyzing records, updating databases, and participating in training sessions to stay current on coding updates.

What are the key skills and qualifications needed to thrive as an entry level risk adjustment coder?

To thrive as an Entry Level Risk Adjustment Coder, you need a strong understanding of medical terminology, anatomy, and ICD-10-CM coding guidelines, typically supported by completion of a coding training program or relevant coursework. Familiarity with coding software, electronic medical records (EMR) systems, and coding certification such as CPC or CRC is often preferred. Attention to detail, analytical thinking, and effective communication are essential soft skills for this role. These skills and qualifications ensure the accurate coding of diagnoses for risk adjustment, compliance with regulations, and contribute to optimal healthcare reimbursement.

What are the most commonly searched types of Risk Adjustment Coder jobs in Missouri?

The most popular types of Risk Adjustment Coder jobs in Missouri are:

What are popular job titles related to Entry Level Risk Adjustment Coder jobs in Missouri?

For Entry Level Risk Adjustment Coder jobs in Missouri, the most frequently searched job titles are:

What job categories do people searching Entry Level Risk Adjustment Coder jobs in Missouri look for?

The top searched job categories for Entry Level Risk Adjustment Coder jobs in Missouri are:

What cities in Missouri are hiring for Entry Level Risk Adjustment Coder jobs?

Cities in Missouri with the most Entry Level Risk Adjustment Coder job openings:

Entry Level Risk Adjustment Coder jobs near you
Infographic showing various Entry Level Risk Adjustment Coder job openings in Missouri as of August 2026, with employment types broken down into 96% Full Time, and 4% Contract. Highlights an 96% In-person, and 4% Hybrid job distribution.

Fraud Investigator-Kansas City, MO area

Blue Cross and Blue Shield of Kansas City

Kansas City, MO • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 20 days ago

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
  • Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
  • Annual incentive bonus plan based on company achievement of goals
  • Time away from work including paid holidays, paid time off and volunteer time off
  • Professional development courses, mentorship opportunities, and tuition reimbursement program
  • Paid parental leave and adoption leave with adoption financial assistance
  • Employee discount program

Job Description Summary:
As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify potential fraud, waste, and abuse (FWA) and claim overpayments. Assigned cases and projects are generally of moderate complexity and performed with limited oversight.
Job Description
  • Assist in performing ongoing FWA risk assessments, leveraging data analytics to identify trends, patterns, outliers relative to peers and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator, evaluate FWA risks and prioritize for further review, based upon member health/safety and protection of plan assets.
  • Monitor hotlines, internal referrals, external fraud alerts (e.g., CMS, BCBSA), external healthcare anti-fraud workgroups, and other resources for potential FWA schemes.
  • Conduct investigations of fraud, waste and abuse in accordance with SIU policies and procedures. May work with Manager and/or Senior Investigator on larger, more complex, investigations.
  • Create and maintain detailed case files in accordance with SIU policies and procedures, where key investigative activities and outcomes are timely and accurately documented
  • Prepare detailed case reports summarizing investigative findings and recommendations. Present reports to key stakeholders (e.g., Provider Relations, Medical Management, Pharmacy, Claims, Legal)
  • Assist in coordinating responses to subpoenas and preparation of cases for referral to law enforcement and/or regulators.
  • Perform day-to-day activities for vendor-based claim overpayment recovery program (e.g., data file exchanges, proposing / reviewing new audit concepts, coordinating claim adjustments, invoices).
  • Assist in preparing reports for executive updates, Blue KC Audit Committee, BCBSA/FEP surveys, and other reports as needed.
  • Support the FWA training program for Blue KC employees and First Tier, Downstream and Related entities.

Minimum Qualifications
  • Bachelor's degree in criminal justice, finance, accounting, medical or other relevant academic discipline. 1 years investigative experience in the following areas (e.g., medical review, financial, medical analytics, behavioral health, research & adjustment, appeals) that provided the types and levels of knowledge, skills, and abilities required.
  • Strong communication skills with a broad range of individuals and groups (e.g., members, providers, operational areas, medical directors, provider relations, legal counsel, senior management)

Preferred Qualifications
  • Master's degree in criminal justice, finance, accounting, medical or other relevant academic discipline
  • 3 years' experience conducting healthcare FWA investigations at a health insurer; experience analyzing claims data to identify FWA trends and patterns using tools such as Excel and business intelligence platforms (e.g., Power BI, Business Objects).
  • Knowledge of major BCBSKC business systems (e.g., Facets, ITS Host and Home) and operational processes (e.g., Claims Processing, Pharmacy, Provider Contracting/Relations, Member Services, Customer Service)
  • Knowledge of BCBSKC provider contracts, medical policies and member benefits
  • Knowledge of medical terminology and ICD/CPT coding
  • Experience working with the regulators (e.g., CMS, State Department of Insurance) and law enforcement (e.g., FBI, DEA, HHS-OIG, OPM-OIG and/or Department of Justice)
  • Juris Doctorate
  • Coding Certification: AAPC, AHIMA
  • FWA Certification: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI)
  • Medical License: Registered Nurse (RN), Licensed Practical Nurse (LPN), pharmacist, physician
  • Licensed Clinal Social Worker (LCSW)
  • Licensed Professional Counselor (LPC)

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

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