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Freelance Hcc Risk Adjustment Coder Jobs in California

Urrly

Telehealth Nurse Practitioners

Los Angeles, CA · Remote

$600 - $720/day

Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits * Review medical history, medications, and preventive needs * Document visits using ICD-10 and CPT II ...

UCLA Health

Coding Supervisor

Los Angeles, CA · Remote

$65K - $130K/yr

CPMA (Certified Professional Medical Auditor), CHC (Certified in Healthcare Compliance), HCC (Risk Adjustment Coding Certification) or Specialty Certification * Familiarity with revenue cycle ...

Astiva Health

Healthcare Data Analyst

Orange, CA · On-site

$85K - $115K/yr

Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements. * Experience analyzing pharmacy adherence metrics ...

Astiva Health

Healthcare Data Analyst

Orange, CA

$85K - $115K/yr

Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements. * Experience analyzing pharmacy adherence metrics ...

UCLA Health

Coding Supervisor

Los Angeles, CA · On-site

$65K/yr

CPMA (Certified Professional Medical Auditor), CHC (Certified in Healthcare Compliance), HCC (Risk Adjustment Coding Certification) or Specialty Certification * Familiarity with revenue cycle ...

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Freelance Hcc Risk Adjustment Coder information

What are the key skills and qualifications needed to thrive as a freelance HCC risk adjustment coder?

To thrive as a Freelance HCC Risk Adjustment Coder, you need a solid understanding of medical coding, ICD-10-CM classification, and risk adjustment models, typically backed by a coding certification such as CPC, CRC, or CCS. Familiarity with Electronic Health Record (EHR) systems, coding software, and payer-specific risk adjustment platforms is essential. Attention to detail, time management, and strong analytical and communication skills help you accurately review records and collaborate with healthcare providers. These skills ensure precise coding, optimize reimbursement, and maintain compliance in a remote, deadline-driven environment.

How does a freelance HCC risk adjustment coder typically collaborate with healthcare providers and coding teams remotely?

As a Freelance HCC Risk Adjustment Coder, you will often work independently but maintain regular communication with healthcare providers, auditors, and coding managers through secure online platforms, emails, or virtual meetings. You may be responsible for clarifying documentation, discussing complex coding scenarios, and providing feedback to providers to ensure accurate risk adjustment coding. Effective collaboration and clear communication are essential to resolve discrepancies and maintain compliance with regulatory standards. Most clients provide access to their electronic health record (EHR) systems and expect timely deliverables, so strong organizational and time management skills are important.

What is a freelance HCC risk adjustment coder?

A Freelance HCC Risk Adjustment Coder is a healthcare professional who works independently to review medical records and assign appropriate ICD-10 codes based on Hierarchical Condition Categories (HCC). Their work supports accurate risk adjustment for insurance plans, particularly Medicare Advantage, by ensuring that patient diagnoses are properly documented and coded. This helps health plans receive correct reimbursement for the care of high-risk patients. Freelance coders have the flexibility to work with multiple clients and often work remotely.

What is the difference between Freelance Hcc Risk Adjustment Coder vs Hcc Risk Adjustment Coder?

AspectFreelance Hcc Risk Adjustment CoderHcc Risk Adjustment Coder
CredentialsCertifications in medical coding, HCC coding experienceCertifications in medical coding, HCC coding experience
Work EnvironmentRemote, independent contractingTypically employed by healthcare organizations or coding companies
Employer & Industry UsageFreelance platforms, independent practiceHospitals, insurance companies, healthcare providers
Search & Comparison IntentLooking for freelance opportunities or contract workSeeking full-time or staff coding roles

Both roles require similar certifications and skills in HCC coding. The main difference is that a Freelance Hcc Risk Adjustment Coder works independently on a contract basis, often remotely, while an Hcc Risk Adjustment Coder is typically employed full-time by healthcare organizations. Your choice depends on your preferred work environment and employment type.

What are the most commonly searched types of Hcc Risk Adjustment Coder jobs in California? The most popular types of Hcc Risk Adjustment Coder jobs in California are:
What are popular job titles related to Freelance Hcc Risk Adjustment Coder jobs in California? For Freelance Hcc Risk Adjustment Coder jobs in California, the most frequently searched job titles are:
What job categories do people searching Freelance Hcc Risk Adjustment Coder jobs in California look for? The top searched job categories for Freelance Hcc Risk Adjustment Coder jobs in California are:
What cities in California are hiring for Freelance Hcc Risk Adjustment Coder jobs? Cities in California with the most Freelance Hcc Risk Adjustment Coder job openings:
Freelance Hcc Risk Adjustment Coder jobs near you
Infographic showing various Freelance Hcc Risk Adjustment Coder job openings in California as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 9% Part Time, 2% Temporary, and 2% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution.

MSO PHYSICIAN REVIEWER

North East Medical Services

Burlingame, CA • On-site

$285K - $332K/yr

Other

Re-posted 9 days ago

Job description

The MSO Physician Reviewer is responsible for ensuring the appropriate utilization of healthcare services while maintaining high standards of patient care. This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes. The Physician Reviewer collaborates with healthcare providers, UM team members, and case managers to facilitate efficient and effective care delivery.
In addition to utilization management, this role contributes case management, quality improvement initiatives, and risk adjustment analysis by identifying trends in healthcare utilization, evaluating provider documentation, and ensuring compliance with federal, state, and organizational policies. The Physician Reviewer provides clinical leadership in optimizing care pathways, reducing unnecessary hospitalizations, and enhancing patient safety.
This position requires a deep understanding of medical policies, healthcare regulations, and payer guidelines, including Medicare and Medicaid benefit coverage criteria. The ideal candidate will have strong analytical skills, excellent communication abilities, and a commitment to ensuring equitable, high-quality care. Work is varied, highly complex, and requires a high degree of discretion and independent judgment.
ESSENTIAL JOB FUNCTIONS:
  • Evaluate medical necessity, appropriateness, and efficiency of healthcare services using evidence-based criteria (e.g., MCG, CMS, and NCQA guidelines).
  • Review and assess prior authorization requests for procedures, hospital admissions, specialty referrals, and medications.
  • Provide peer-to-peer consultations with treating physicians to discuss medical necessity determinations and alternative treatment options.
  • Participate in the appeals and grievance process by reviewing denied claims and reconsidering medical necessity based on additional documentation.
  • Conduct retrospective and concurrent reviews of medical records to ensure accurate risk stratification and appropriate coding and documentation based on patient complexity.
  • Analyze Hierarchical Condition Category (HCC) coding and Risk Adjustment Factor (RAF) scores to identify documentation gaps and ensure alignment with CMS risk adjustment models.
  • Support provider education on proper documentation and coding practices to reflect complete and accurate disease burden and clinical acuity.
  • Participate in chart reviews and audits to ensure compliance with risk adjustment methodologies and HCC coding.
  • Evaluate coding trends and audit results to identify undercoded or miscoded diagnoses that may impact risk scores and compliance.
  • Work collaboratively with case managers, social workers, and care teams to optimize patient care and resource utilization.
  • Support efforts to reduce readmissions and enhance patient outcomes through evidence-based interventions.
  • Participate in quality improvement initiatives, such as identifying trends in over- or underutilization, gaps in care, or process inefficiencies.
  • Collaborate with clinical and operational leadership to develop protocols and guidelines that enhance patient safety and care quality.
  • Review and analyze clinical data to support performance improvement projects and accreditation requirements.
  • Performs other job duties as required by manager/supervisor.

  • Medical Degree (MD or DO) from an accredited institution.
  • Board Certification in a relevant specialty (Internal Medicine, Family Medicine, Emergency Medicine, or another applicable field).
  • Active and unrestricted medical license in California.
  • Minimum of 3-5 years of clinical experience; prior experience in utilization management, case review, HCC, risk adjustment, or managed care is preferred.
  • Knowledge of medical necessity criteria, healthcare regulations, and payer policies (Medicare, Medicaid, and/or commercial insurance).
  • Familiarity with UM guidelines (MCG, InterQual, CMS, NCQA, URAC) and utilization review process.
  • Experience conducting peer-to-peer reviews and provider education sessions.
  • Strong understanding of risk adjustment methodologies (e.g. HCC coding and RAF scoring) preferred.
  • Knowledge of value-based care models, population health management, and healthcare cost containment strategies.
  • Supervisory experience in a healthcare setting a plus.

LANGUAGE:
  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred
  • Fluency in other languages are an asset.

STATUS:
  • This is an FLSA exempt position.
  • This is not an OSHA high-risk position.
  • This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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