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Remote Hcc Risk Adjustment Coder Jobs in Springboro, OH

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 ...

SIERTEK LTD

Web Developer* (26.27)

Dayton, OH · On-site +1

Write clean, efficient, maintainable, and well-documented code. * Participate in a structured ... Perform database maintenance and development through secure remote access (VPN) and on-site support ...

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

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 ...

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 ...

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 ...

FarmaceuticalRX

Payroll & Benefits Specialist

Dayton, OH · Remote

Partner with payroll to ensure accurate deductions, retroactive adjustments, and reconciliation of ... Review and reconcile payroll data against timekeeping, benefits deductions, and leave/LOA coding to ...

FarmaceuticalRX

Payroll & Benefits Specialist

Dayton, OH · On-site +1

$60K - $70K/yr

Partner with payroll to ensure accurate deductions, retroactive adjustments, and reconciliation of ... Review and reconcile payroll data against timekeeping, benefits deductions, and leave/LOA coding to ...

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.

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.

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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$13

$19

$30

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

As of Sep 2, 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 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 the key skills and qualifications needed to thrive as a remote HCC risk adjustment coder?

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 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

Director, Model Engineering & Operations

CareSource

Dayton, OH • On-site, Remote

Full-time

Posted 27 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

208th of 315 rated insurance

Job description

Job Summary:
The Director, Model Engineering & Operations is responsible for leading the strategy, development, implementation, and optimization of enterprise AI and machine learning solutions that support core health plan operations and business objectives. This role provides leadership for the design and delivery of scalable, secure, and compliant AI/ML platforms and production systems, while overseeing the end-to-end machine learning lifecycle. The Director leads a team of machine learning engineers and applied scientists and collaborates across business and technology functions to translate advanced analytics and artificial intelligence capabilities into reliable, cost-effective, and operationalized solutions that drive organizational performance and innovation.
Essential Functions:
  • Lead the design, development, and productionization of ML and AI models across risk adjustment (HCC/RAF), HEDIS/Stars quality measures, care management, utilization management, fraud/waste/abuse, and member/provider experience use cases.
  • Own the end-to-end MLOps lifecycle on Databricks: feature engineering and feature store design, model training and versioning (MLflow), CI/CD for ML pipelines, deployment patterns (batch, real-time, and streaming inference), and automated retraining.
  • Establish and enforce model monitoring practices - drift detection, performance degradation alerts, bias/fairness checks, and champion-challenger frameworks - to ensure production models remain accurate and compliant over time.
  • Guide the evaluation and responsible adoption of generative AI and LLM-based capabilities (e.g., Mosaic AI, Genie, retrieval-augmented generation) for internal analytics, member/provider-facing tools, and operational automation.
  • Define engineering standards, design patterns, and reusable components (feature libraries, model templates, deployment scaffolding) to accelerate delivery across the data science and ML engineering teams.
  • Partner with data governance and security teams to ensure all ML/AI systems comply with HIPAA, CMS, and NCQA requirements, including PHI handling, access controls, and audit trails within Unity Catalog.
  • Manage model risk documentation and validation processes suitable for regulatory review (e.g., RADV audits, Stars/HEDIS submissions) in partnership with compliance and quality teams.
  • Own the cost, performance, and reliability of the ML platform footprint on Databricks, including compute optimization, cluster/job design, and vendor/tooling evaluation (e.g., build vs. buy decisions for platform capabilities).
  • Collaborate with BI, data engineering, and data science teams to ensure ML features and pipelines align with the broader canonical data model and lakehouse architecture.
  • Translate business problems from clinical, quality, finance, and operations stakeholders into well-scoped ML engineering initiatives with clear success metrics and delivery timelines.
  • Communicate technical strategy, risk, and progress to senior leadership and non-technical stakeholders in clear, business-relevant terms.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in Computer Science, Data Science, Engineering, or a related field required
  • Master's degree in Computer Science, Data Science, Engineering preferred
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Eight (8) years in software/ML engineering required
  • Five (5) years of leadership experience required
  • Experience productionizing ML models at scale, including MLOps practices (CI/CD, model versioning, monitoring, retraining pipelines) required
  • Experience operating within regulated, PHI-governed environments; working knowledge of HIPAA and healthcare data standards required
Competencies, Knowledge and Skills:
  • Familiarity in a health plan, payer, or healthcare provider environment, with exposure to HEDIS/Stars, HCC risk adjustment, claims (837/835), and clinical data standards (HL7, FHIR, CCDA)
  • Knowledgeable in cloud infrastructure (Azure preferred, given Databricks-on-Azure deployment) and Infrastructure-as-Code practices
  • Hands-on proficiency with Databricks (or comparable lakehouse platform), Delta Lake, MLflow, and Spark; strong Python and SQL skills
  • Solid understanding of ML fundamentals (supervised/unsupervised learning, model evaluation, feature engineering) and modern AI/LLM concepts (RAG, embeddings, prompt engineering, model evaluation for generative systems)
  • Ability to evaluate or implement knowledge graph, entity resolution, or Member 360-style initiatives
  • Strong communication skills with the ability to influence both technical teams and executive stakeholders
  • Ability to present model risk or AI governance documentation to regulators, auditors, or compliance committees
  • Strong service orientation and consulting skills
  • Ability to work collaboratively with all levels of management
  • Ability to juggle multiple complex priorities within a changing environment
  • Strong leadership and management skills with the ability to motivate in a team-orientated, collaborative environment
  • Strong knowledge of outsourcing and staff augmentation strategies supporting testing processes
  • Knowledge of the managed care industry is preferred
  • Exceptionally self-motivated and directed
Licensure and Certification:
  • None
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Ability to travel as required by the needs of the business.

Compensation Range:
$135,600.00 - $237,400.00
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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Brand=CareSource

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