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Freelance Remote Risk Adjustment Coder Jobs in Ohio

Procter & Gamble

CopywriterFlexible

Cincinnati, OH · Remote

EM66D Category: R&D Design, Onsite/Remote A Copywriter is responsible for creating persuasive and ... Measure the results of marketing campaigns, analyze data, and make adjustments to optimize ...

CareSource

Applied AI Scientist III

Dayton, OH · On-site +1

... expertise and code reviews. Essential Functions: * Evaluate emerging technology in LLMs, NLP ... Work closely with interdisciplinary teams across IT, risk adjustment, program integrity, HEDIS ...

Quadax, Inc.

Receipt Poster

Cleveland, OH · On-site +1

$18 - $20/hr

Although this position is listed as remote, the new team member will be required to complete 5 days ... Post contracted and negotiated adjustments when applicable. * Determine the cause of credit ...

Signet Jewelers Ltd.

Xstore Developer (Remote)

Akron, OH · On-site +1

$74K - $125K/yr

Dallas, TX or Akron, OH (Hybrid) Preferred Open to remote POSITION SUMMARY : The Developer is ... Participate in technical walkthroughs and code reviews. * Migrate complex, high-risk solutions into ...

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Freelance Remote Risk Adjustment Coder information

What are Freelance Remote Risk Adjustment Coders?

Freelance Remote Risk Adjustment Coders are healthcare professionals who work independently from various locations to review medical records and assign codes that reflect patients’ health conditions and treatments, focusing on risk adjustment models. Their primary role is to ensure accuracy in coding so that healthcare organizations receive appropriate reimbursement and maintain compliance with regulatory standards. These coders typically work on a contract basis, using secure digital platforms to access records and submit their coding work. They must be highly knowledgeable in ICD-10-CM coding guidelines, risk adjustment methodologies (such as HCC), and HIPAA regulations.

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

Thriving as a Freelance Remote Risk Adjustment Coder requires deep knowledge of medical coding (especially ICD-10-CM), risk adjustment models, and compliance standards, typically verified by certifications like CRC, CPC, or CCS. Proficiency with coding software, EHR systems, and secure remote work platforms is essential for accurate and efficient coding. Strong attention to detail, self-motivation, and reliable communication are vital soft skills for managing independent workloads and collaborating with clients remotely. These abilities ensure accurate risk score calculations, regulatory compliance, and successful client relationships in a virtual work environment.

How do Freelance Remote Risk Adjustment Coders typically manage communication and workflow with healthcare clients and team members?

Freelance Remote Risk Adjustment Coders commonly use secure online platforms and project management tools to receive assignments, submit coded charts, and communicate with healthcare providers or project managers. Maintaining clear and prompt communication via email or dedicated messaging systems is crucial to clarify documentation, resolve coding queries, and ensure deadlines are met. Coders must be proactive in scheduling regular check-ins and staying updated on client-specific guidelines, as workflows can be fast-paced and require strong organizational skills. Collaboration often involves working independently but also participating in virtual meetings or training sessions to stay aligned with team quality standards.
What are the most commonly searched types of Remote Risk Adjustment Coder jobs in Ohio? The most popular types of Remote Risk Adjustment Coder jobs in Ohio are:
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Freelance Remote Risk Adjustment Coder jobs near you
Quality Risk Adjustment Advisor IV (Health Plan experience required)

Quality Risk Adjustment Advisor IV (Health Plan experience required)

CareSource

Dayton, OH • On-site, Remote

$83K - $132K/yr

Full-time

Posted 22 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

183rd of 281 rated insurance

Job description

Job Summary:
The Quality Risk Adjustment Advisor IV is responsible for leading key components of the Quality Risk Adjustment (QRA) programs, including prospective programs, chart retrieval and coding processes, while ensuring compliance with regulatory standards and optimizing quality outcomes. This role partners closely with internal stakeholders and external vendors to enhance operational effectiveness and leverage artificial intelligence (AI) technologies to improve data accuracy, efficiency, and overall program performance.
Essential Functions:
  • Serve as a subject matter expert in Risk Adjustment operations, supporting prospective programs, chart retrieval and coding processes.
  • Identify and recommend strategies to optimize risk adjustment processes and improve quality metrics across insourced and outsourced activities, including leveraging AI for process enhancement.
  • Partner with vendors to support execution of operational production plans and contractual requirements.
  • Monitor vendor performance and identify opportunities to improve efficiency, quality, and cost management.
  • Collaborate with QRA Compliance to support development and maintenance of quality assurance protocols.
  • Conduct audits and assessments to ensure accuracy, completeness, and efficiency.
  • Research and evaluate technological solutions, including AI/NLP tools.
  • Partner with Data Science, IT, and Sourcing teams to support deployment of AI solutions.
  • Collaborate with cross-functional teams to support operational goals.
  • Identify and implement process improvements.
  • Monitor and analyze key performance indicators (KPIs).
  • Gather and translate business requirements into actionable recommendations.
  • Assess build vs. buy AI solutions.
  • Support evaluation and monitoring of AI solution performance.
  • Provide guidance and informal coaching to stakeholders as needed.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in Health Administration, Healthcare Management, or a related field required
  • Master's degree is preferred
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Seven (7) years experience in risk adjustment, medical record review, coding, or quality management required
  • Two (2) years experience with AI solutions in a healthcare setting required
  • Leadership experience preferred
Competencies, Knowledge and Skills:
  • Knowledge of ICD-10 Coding
  • Knowledge of HCC Risk Adjustment models
  • Knowledge of CMS regulatory guidelines
  • Strong analytical and problem-solving skills
  • Ability to apply AI technologies in healthcare
  • Strong communication and collaboration skills
  • Ability to influence stakeholders without direct authority
Licensure and Certification:
  • None
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$83,000.00 - $132,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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