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From Home Hcc Risk Adjustment Coder Jobs in California

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From Home Hcc Risk Adjustment Coder information

What is a from home HCC risk adjustment coder?

From Home HCC Risk Adjustment Coders are health information professionals who work remotely to review medical records and assign appropriate codes based on Hierarchical Condition Categories (HCC) for risk adjustment purposes. Their work ensures that healthcare providers receive accurate reimbursement from insurance companies, particularly Medicare Advantage plans. These coders must have a strong understanding of ICD-10-CM coding guidelines, clinical documentation, and risk adjustment models. Working from home allows for flexibility, but still requires strict attention to detail and adherence to privacy regulations.

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

To thrive as a From Home HCC Risk Adjustment Coder, you need a thorough understanding of ICD-10-CM coding, risk adjustment models, and medical terminology, usually backed by a coding certification such as CPC, CRC, or CCS. Familiarity with electronic health record (EHR) systems, coding software, and secure remote work platforms is essential. Strong attention to detail, time management, and self-motivation are vital soft skills for ensuring accuracy and productivity while working independently. These skills are crucial for maintaining compliance, optimizing reimbursement, and ensuring data integrity in a remote environment.

What are some common challenges faced by from home HCC risk adjustment coders, and how can they be managed?

From Home HCC Risk Adjustment Coders often face challenges such as interpreting complex medical records, staying updated with evolving coding guidelines, and managing productivity without in-person supervision. To overcome these, coders should prioritize ongoing education, use reliable coding resources, and maintain clear communication with their remote team. Setting a structured daily routine and participating in virtual team check-ins can also help maintain focus and ensure consistent quality in code assignments.

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:

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For From Home Hcc Risk Adjustment Coder jobs in California, the most frequently searched job titles are:

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From Home Hcc Risk Adjustment Coder jobs near you

Senior Consultant, Health Care Data Analytics

COPE Health Solutions

Los Angeles, CA • On-site

$111K - $139K/yr

Full-time

Posted 20 days ago

Job description

The Senior Consultant will work with cross-functional teams in a centralized consulting role supporting multiple client engagements and internal operational initiatives. The Senior Consultantis responsible forindependent ownership of major analytical workstreamsas well as definingmethodologyand reporting logic. Thisincludes, but is not limited to,designing, developing,maintaining, and executing healthcare analytics and reporting solutions that enable clients and internal leadership to evaluate performance,identifyopportunities, and improve outcomes across value-based care programs.

This position partners closely with consulting, product, engineering, clinical, and client stakeholders to translate complex healthcare data into meaningful insights that drive operational efficiency, quality improvement,utilizationmanagement, care management performance, risk adjustment optimization, and financial success.The ideal candidatemust beaccountable for deliverable quality and deadlines,comfortable with direct presentation to client executives,possessesdeep healthcare dataexpertise, SQL development skills, strong analytical thinking, and an ability toleverageAI-enabled technologies to improve reporting and analytics capabilities.

FLSA Status

Exempt

Salary Range

$111,600 - $139,400

Reports To

Director, Medical Economics

Direct Reports

None

Location

Los Angeles, CA Hybrid

Travel

Up to 40%

Work Type

Regular

Schedule

Full Time

Position Description

  • Design, develop, automate,maintain, and execute client-facing and internal dashboards, reports, scorecards, and recurring analytics supporting value-based care initiatives.
  • Translate client and stakeholder business requirements into scalable reporting and analytical solutions using SMSS SQL, Excel, and other business intelligence tools.
  • Analyze healthcare claims, EMR, and operational datasets toidentifyactionable opportunities related to quality performance, care management,utilizationmanagement, prior authorization, HCC risk adjustment, population health, and medical cost/utilization.
  • Develop executive-readyreporting that highlights operational efficiencies, outcomes, successes, failures, emerging trends, and strategic opportunities.
  • Validate healthcare data for completeness, accuracy, consistency, and adherence to business rules while ensuring reporting integrity and reproducibility.
  • Collaborate with product, engineering, consulting, and implementation teams to map client-specific data elements and define reporting logic aligned with client requirements.
  • Investigate data anomalies, perform root cause analyses, and recommend solutions that improve data quality andaccuratereporting.
  • Support implementation of new reporting capabilities for value-based care programs including MSSP, ACO REACH, Medicare Advantage, Commercial Risk, and Medicaid value-based arrangements.
  • Present analytical findings to both technical and executive audiences in a clear, actionable manner.
  • Utilize AI-enabled technologies to accelerate report development,optimizeSQL coding, improve documentation, automate repetitive analytical processes, andidentifyinnovative opportunities for enhancing client value.
  • Contribute to continuous improvement initiatives that modernize analytics capabilities, increase operational efficiency, and strengthen consulting delivery.
  • Review or quality oversight of junior team members.
  • Project leadership or information mentorship.

Qualifications

  • Graduate degree with a quantitative, healthcare, business or technical focuspreferred,bachelor's degree and applicable experience will be considered.
  • 3+ years of professional experience performinghealthcare analytics within a consulting firm, health system, payer, accountable care organization, or healthcare technology organization.
  • Demonstrated experience working with healthcare claims and eligibility data (professional, institutional, and pharmacy).
  • Experience with Electronic Medical Record (EMR/HER) and Utilization Management and Prior Authorization datasets preferred
  • ProficiencyinSQL
  • Familiarity of data visualization and Business Intelligence platforms
  • Working knowledgeofvalue-based care programsand healthcare risk-based arrangements includingMSSP, ACO REACH, Medicare Advantage, and alternative payment models.
  • Experience supporting HCC Risk Adjustment, quality, care management reporting, andutilizationmanagement analytics.
  • Strong consulting, project management, and stakeholder relationship management skills.
  • ExperienceutilizingAI technologies (e.g., ChatGPT, Microsoft Copilot, Claude, GitHub Copilot, or similar tools) to improve analytics development, SQL optimization, reporting automation, and operational efficiency.
  • Excellent written and verbal communication skills with the ability to explain technical concepts to both technical and business audiences.

Benefits

As a firm passionate about health care,we'redeeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend forwellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here:https://copehealthsolutions.com/careers/


About COPE Health Solutions
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deepexpertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, healthplansand self-insured employers. For moreinformation, visithttps://copehealthsolutions.com/about-us/


To Apply: To apply for this position or for more information about COPE Health Solutions, visit us athttps://copehealthsolutions.com/careers/open-positions/

Employment Type: Full-Time

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