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Remote Hcc Risk Adjustment Coder Jobs in Springboro, OH

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 ...

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

... adjustment and other transactions. The Medical Billing Specialist performs daily, monthly and special system processing requirements (i.e. batch posting and balancing). 1) Coding/Charge Review a ...

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

... adjustment and other transactions. The Medical Billing Specialist performs daily, monthly and special system processing requirements (i.e. batch posting and balancing). 1) Coding/Charge Review a ...

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

... adjustment and other transactions. The Medical Billing Specialist performs daily, monthly and special system processing requirements (i.e. batch posting and balancing). 1) Coding/Charge Review a ...

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

... adjustment and other transactions. The Medical Billing Specialist performs daily, monthly and special system processing requirements (i.e. batch posting and balancing). 1) Coding/Charge Review a ...

SAIC

Data Analyst - GEOINT Technical SME

Dayton, OH · Remote

$120K - $160K/yr

TS/SCI with Poly Potential for Remote Work: ORA_ON_SITE Description The Data Analyst - GEOINT ... Support the sustainment of risk scoring tools and other data analysis implementations by ...

SciTec

Senior Software Engineer

Dayton, OH · On-site +1

$119K - $157K/yr

... remote sensing algorithms, tools, and techniques to deliver world-class data exploitation ... Identify technical risks and propose risk-reduction strategies to support program success

SciTec

Sr. Staff Software Engineer

Dayton, OH · On-site +1

$119K - $157K/yr

... remote sensing algorithms, tools, and techniques to deliver world-class data exploitation ... Identify technical risks and propose risk-reduction strategies to support program success

SierTeK Ltd.

Backend Tester

Dayton, OH · Remote

SierTeK Ltd. is seeking a Backend Tester to support a remote opportunity (with preference for ... Participate in code and solution review discussions as needed to improve testability and quality

SIERTEK LTD

Backend Tester*

Beavercreek, OH · Remote

SierTeK Ltd. is seeking a Backend Tester to support a remote opportunity (with preference for ... Participate in code and solution review discussions as needed to improve testability and quality

SIERTEK LTD

Backend Tester*

Beavercreek, OH · On-site +1

SierTeK Ltd. is seeking a Backend Tester to support a remote opportunity (with preference for ... Participate in code and solution review discussions as needed to improve testability and quality

ERP Suites

AI Software Engineer

Loveland, OH · On-site +1

Although the position will be remote, there might be some occasional travel to ERPS facilities or ... Participate in design reviews, code reviews, and release activities. * Partner with stakeholders to ...

ERP Suites

AI Software Engineer

Loveland, OH · Remote

Although the position will be remote, there might be some occasional travel to ERPS facilities or ... Participate in design reviews, code reviews, and release activities. * Partner with stakeholders to ...

Booz Allen Hamilton

Data Analyst

Dayton, OH · On-site +1

$61K - $141K/yr

Support the sustainment of risk scoring tools and other data analysis implementations by ... Experience coding to support writing scripts with tools, such as Java and Python * Experience using ...

System One

Senior Java Developer

Evendale, OH · Remote

$110K - $130K/yr

Direct Hire Compensation: $110,000 - $130,000 Hybrid - onsite Tue, Wed, Thr, remote Mon, Fri ... efficiencies, reduce risk, ensure compliance, and promote business agility and innovation.

System One

Senior Java Developer -

Evendale, OH · Remote

$110K - $130K/yr

Direct Hire Compensation: $110,000 - $130,000 Hybrid - onsite Tue, Wed, Thr, remote Mon, Fri ... efficiencies, reduce risk, ensure compliance, and promote business agility and innovation.

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How much do remote hcc risk adjustment coder jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for remote hcc risk adjustment coder in Springboro, OH is $19.77, according to ZipRecruiter salary data. Most workers in this role earn between $15.91 and $21.20 per hour, depending on experience, location, and employer.

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

To thrive as a Remote HCC Risk Adjustment Coder, you need a solid understanding of ICD-10-CM coding guidelines, risk adjustment models, and extensive experience in medical record review, typically supported by a relevant coding certification such as CPC or CRC. Proficiency with electronic health record (EHR) systems, coding software, and risk adjustment platforms is essential. Exceptional attention to detail, analytical thinking, and strong communication skills help coders excel in remote settings and ensure coding accuracy. These skills and qualifications are vital for optimizing risk scores, ensuring compliance, and supporting accurate reimbursement in healthcare organizations.

What is a Remote HCC Risk Adjustment Coder?

A Remote HCC Risk Adjustment Coder is a medical coding professional who works from home or another remote location, reviewing patient medical records to assign Hierarchical Condition Category (HCC) codes. These codes are used by healthcare organizations to accurately reflect the severity of patient illnesses for risk adjustment and reimbursement purposes, especially in Medicare Advantage programs. The coder analyzes clinical documentation to ensure that diagnoses are coded correctly and in compliance with regulatory guidelines. Their work is essential for ensuring healthcare providers receive appropriate compensation and for maintaining accurate patient risk profiles.

What are some common challenges faced by remote HCC Risk Adjustment Coders and how can they be managed?

Remote HCC Risk Adjustment Coders often encounter challenges such as interpreting incomplete or ambiguous medical documentation, staying updated with evolving coding guidelines, and managing communication across dispersed teams. To address these challenges, it's important to proactively seek clarification from providers, participate in ongoing training, and utilize collaboration tools to stay connected with peers and supervisors. Establishing a structured daily workflow and leveraging available resources can also help maintain coding accuracy and productivity in a remote setting.
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Remote Hcc 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 18 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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