Auditor, Risk Adjustment
Atlanta, GA · Remote
$82K - $108K/yr
The Associate, Risk Adjustment Auditor conducts internal and external quality audits ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...
Atlanta, GA · Remote
$82K - $108K/yr
The Associate, Risk Adjustment Auditor conducts internal and external quality audits ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...
Atlanta, GA · Remote
$82K - $108K/yr
The Associate, Risk Adjustment Auditor conducts internal and external quality audits ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...
Atlanta, GA · On-site
$41.85/hr
Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS ... Certified Risk Coder (CRC) * Certified Coding Specialist (CCS) * Registered Health Information ...
Atlanta, GA · On-site
$41.85/hr
Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS ... Certified Risk Coder (CRC) * Certified Coding Specialist (CCS) * Registered Health Information ...
Atlanta, GA · On-site
Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies. * Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.
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Atlanta, GA · On-site
Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies. * Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.
Atlanta, GA · On-site +1
$600 - $720/day
Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits * Review medical history, medications, preventive needs * Document visits using ICD-10 and CPT II ...
Atlanta, GA · On-site +1
$600 - $720/day
Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits * Review medical history, medications, preventive needs * Document visits using ICD-10 and CPT II ...
Become a part of our caring community The Risk Adjustment Coding Analyst provides operational, analytical, and administrative support to business leaders and teams. You will analyze data to support ...
Become a part of our caring community The Risk Adjustment Coding Analyst provides operational, analytical, and administrative support to business leaders and teams. You will analyze data to support ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Atlanta, GA · On-site
$143K - $229K/yr
Deep experience with ACA Risk Adjustment , including HHS-HCC model methodology, risk score ... Strong understanding of diagnosis coding (ICD-10-CM) , provider documentation practices, and their ...
Atlanta, GA · On-site
$143K - $229K/yr
Deep experience with ACA Risk Adjustment , including HHS-HCC model methodology, risk score ... Strong understanding of diagnosis coding (ICD-10-CM) , provider documentation practices, and their ...
... HCC Mode; or any combination of education and experience, which would provide an equivalent ... Prefer AAPC Certified Risk Adjustment Coder (CRC) certification. Please be advised that Elevance ...
... HCC Mode; or any combination of education and experience, which would provide an equivalent ... Prefer AAPC Certified Risk Adjustment Coder (CRC) certification. Please be advised that Elevance ...
... HCC Mode; or any combination of education and experience, which would provide an equivalent ... Prefer AAPC Certified Risk Adjustment Coder (CRC) certification. Job Level: Manager Workshift: Job ...
... HCC Mode; or any combination of education and experience, which would provide an equivalent ... Prefer AAPC Certified Risk Adjustment Coder (CRC) certification. Job Level: Manager Workshift: Job ...
... risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier health plans and VBC provider initiatives. Integrates MOC, HEDIS, Star Ratings, utilization, SNP and HCC ...
... risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier health plans and VBC provider initiatives. Integrates MOC, HEDIS, Star Ratings, utilization, SNP and HCC ...
... risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier health plans and VBC provider initiatives. Integrates MOC, HEDIS, Star Ratings, utilization, SNP and HCC ...
... risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier health plans and VBC provider initiatives. Integrates MOC, HEDIS, Star Ratings, utilization, SNP and HCC ...
... risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier health plans and VBC provider initiatives. Integrates MOC, HEDIS, Star Ratings, utilization, SNP and HCC ...
... risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier health plans and VBC provider initiatives. Integrates MOC, HEDIS, Star Ratings, utilization, SNP and HCC ...
As the Director of CDI & Inpatient Coding, you will influence: * Patient safety and quality ... Severity of illness and risk adjustment accuracy * Physician engagement and education * Regulatory ...
As the Director of CDI & Inpatient Coding, you will influence: * Patient safety and quality ... Severity of illness and risk adjustment accuracy * Physician engagement and education * Regulatory ...
Atlanta, GA · On-site
$120K - $145K/yr
... Risk Adjustment teams, who set strategy and targets; flag practice-level gaps to them and drive practice adoption of the resulting action items. Does not perform chart review, coding audits, or other ...
Atlanta, GA · On-site
$120K - $145K/yr
... Risk Adjustment teams, who set strategy and targets; flag practice-level gaps to them and drive practice adoption of the resulting action items. Does not perform chart review, coding audits, or other ...
Atlanta, GA · On-site
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
Atlanta, GA · On-site
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
Atlanta, GA · On-site
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
Atlanta, GA · On-site
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
$52.37 - $65.06/hr
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
$52.37 - $65.06/hr
... coding accuracy, and provider documentation practices. The analyst plays a key role in driving improvements in Case Mix Index (CMI), risk adjustment, and departmental performance by identifying ...
Audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks. * Receive and review patient charts and documents for accuracy * Ensure that all codes are ...
Audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks. * Receive and review patient charts and documents for accuracy * Ensure that all codes are ...
Manage specific assigned geographic areas and successfully drive the FUJIFILM HCC Risk Biomarkers ... Liaise with office and laboratory staff to provide reimbursement support and test coding.
Manage specific assigned geographic areas and successfully drive the FUJIFILM HCC Risk Biomarkers ... Liaise with office and laboratory staff to provide reimbursement support and test coding.
$15.47 is the 25th percentile. Wages below this are outliers.
$13.40 - $15.52
26% of jobs
$15.52 - $17.64
9% of jobs
$17.64 - $19.76
12% of jobs
The median wage is $20.82 / hr.
$19.76 - $21.88
9% of jobs
$21.88 - $24.01
11% of jobs
$24.01 - $26.13
5% of jobs
$27.72 is the 75th percentile. Wages above this are outliers.
$26.13 - $28.25
6% of jobs
$28.25 - $30.37
5% of jobs
$30.37 - $32.49
5% of jobs
$32.49 - $34.62
3% of jobs
$34.62 - $36.74
10% of jobs
$13
$23
$36
An HCC Risk Adjustment Coder reviews medical records to identify and assign accurate Hierarchical Condition Category (HCC) codes based on documented diagnoses. These codes help determine risk adjustment scores, which impact healthcare reimbursements for Medicare Advantage and other risk-adjusted plans. Coders ensure compliance with CMS guidelines, improve documentation accuracy, and support proper reimbursement for patient care. Strong knowledge of ICD-10-CM coding, medical terminology, and risk adjustment models is essential for this role.
HCC Risk Adjustment Coders often encounter challenges such as incomplete or ambiguous provider documentation, frequent code updates, and tight coding accuracy standards. Staying current on industry coding guidelines, maintaining open communication with providers, and participating in regular training programs are essential strategies for overcoming these hurdles. Coders who proactively seek clarification, double-check their work, and embrace ongoing learning typically excel in this role. Addressing these challenges effectively not only improves coding quality but also supports accurate reimbursement and risk adjustment reporting.
To thrive as an HCC Risk Adjustment Coder, you need a solid understanding of medical coding, ICD-10-CM coding guidelines, and clinical documentation, often demonstrated by a certification such as CPC, CRC, or CCS-P. Familiarity with EHR systems, risk adjustment software, and coding databases is commonly required. Attention to detail, analytical thinking, and strong communication skills set top coders apart in this field. These skills are critical for accurately capturing patient risk, ensuring compliance, and supporting optimal reimbursement for healthcare organizations.
The most popular types of Hcc Risk Adjustment Coder jobs in Georgia are:
For Hcc Risk Adjustment Coder jobs in Georgia, the most frequently searched job titles are:
The top searched job categories for Hcc Risk Adjustment Coder jobs in Georgia are:

$82K - $108K/yr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
This job post has expired 1 day ago. Applications are no longer accepted.
6.9
Based on 6 frontline employees who took The Breakroom Quiz
262nd of 315 rated insurance
Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role:
The Associate, Risk Adjustment Auditor conducts internal and external quality audits. Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.
You will report into the Manager, Risk Adjustment.
Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote
Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities:
Requirements:
Bonus points:
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
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Sourced by ZipRecruiter
Insurance services
1,001 - 5,000 Employees
New York, NY, US
2012