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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 ...

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

As of Jun 16, 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.
What cities near Springboro, OH are hiring for Remote Hcc Risk Adjustment Coder jobs? Cities near Springboro, OH with the most Remote Hcc Risk Adjustment Coder job openings:
Remote Hcc Risk Adjustment Coder jobs near you
Applied AI Scientist III

Applied AI Scientist III

CareSource

Dayton, OH • On-site, Remote

Full-time

Posted 18 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 27 frontline employees who took The Breakroom Quiz

175th of 261 rated insurance

Job description

Job Summary:
The Applied AI Scientist III is responsible for the development and application of cutting-edge advanced analytics solutions using emerging Artificial Intelligence (AI) technologies such as Agentic AI, Retrieval Augmented Generation (RAG), Large Language Models (LLMs), Natural Language Processing (NLP) and Generative AI solutions to enhance healthcare operations, patient care, and overall health plan performance and efficiency. This position requires a highly skilled AI expert capable of delivering complex data science projects independently while guiding other data scientists through technical expertise and code reviews.
Essential Functions:
  • Evaluate emerging technology in LLMs, NLP, Generative AI, and healthcare informatics, integrating these advancements into the projects to drive continuous innovation.
  • Utilize NLP algorithms and other deep learning techniques to process and analyze unstructured healthcare data, such as clinical notes, patient feedback, and medical literature, to extract meaningful insights.
  • Lead development from prototype through production in partnership with engineering/architecture.
  • Co-own operational readiness (evaluation, monitoring requirements, documentation, safeguards) and support post-release tuning of Generative AI solutions (such as prompt engineering and RAG).
  • Lead initiatives specializing in NLP and predictive analytics, ensuring the successful delivery of projects that align with organizational goals.
  • Work closely with interdisciplinary teams across IT, risk adjustment, program integrity, HEDIS, healthcare operations, finance, and clinical departments to identify and capitalize on opportunities for data-driven innovative solutions using cutting-edge emerging technologies.
  • Develop and implement predictive models, algorithms, and statistical techniques to extract insights from large and complex healthcare datasets.
  • Define and execute evaluation strategies for ML and LLM solutions, including quality metrics, bias and safety checks, and performance monitoring after deployment.
  • Utilize machine learning algorithms to identify patterns, trends, and opportunities for improving operational efficiency, cost containment, and patient care.
  • Conduct rigorous data analysis, including data cleansing, feature engineering, and exploratory data analysis, to derive meaningful insights and actionable recommendations.
  • Collaborate with stakeholders to define key performance indicators (KPIs), develop metrics, and create dashboards and reports that effectively communicate insights and support decision-making.
  • Provide strategic guidance and recommendations to senior leadership based on data analysis and predictive modeling results.
  • Ensure compliance with data privacy and security regulations, including HIPAA and PHI handling as applicable and maintain the highest standards of data integrity, model governance, and documentation.
  • Lead cross-functional projects with occasional light project management across teams to deliver results.
  • Represent the department in project meetings and other meetings that require subject matter knowledge and input.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in Data Science, Mathematics, Statistics, Engineering, Computer Science, or other related field required
  • Master's or PhD degree preferred
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Five (5) years of experience in predictive analytics, data science, or a related field, preferably within the healthcare industry or managed care organizations required
  • Five (5) years of experience in the healthcare industry required
  • One (1) year of experience with cloud services (such as Azure, AWS or GCP) and modern data stack (such as Databricks or Snowflake) required
  • One (1) year of experience in development and deployment of an NLP and Generative AI solution in the healthcare industry required

Competencies, Knowledge and Skills:
  • Familiarity with Agentic AI, LLM architecture, prompt engineering, RAG, and evaluation metrics
  • Familiarity with MLOps and LLMOps practices such as CI/CD, model registry, experiment tracking, automated evaluation, monitoring, and reproducible pipelines
  • Understanding of model risk management, AI governance, and responsible AI
  • Strong expertise in statistical modeling, machine learning techniques, and predictive analytics tools such as Python, or R
  • Expert in data manipulation, data visualization, and SQL for data extraction and analysis
  • Ability to perform advanced statistical analysis and modeling such as linear and non-linear regression, sampling, and Markov chains
  • Expertise in emerging technologies and tools such as large language models, natural language understanding, sentiment analysis, named entity recognition, topic modeling, and text classification
  • Expertise in Optical Character Recognition (OCR) technologies, including data extraction from scanned documents, forms, and invoices, and proficiency in OCR tools and libraries
  • Familiarity with web app and API development and deployment in production environment
  • Detailed knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data, and demographic and population data
  • Knowledge of healthcare operations, payer and provider models, and industry trends
  • Proficient in feature engineering techniques and exploratory data analysis
  • Knowledge of optimization techniques and artificial intelligence methods
  • Excellent analytical, problem-solving, and critical-thinking skills, with the ability to translate complex data into actionable insights
  • Strong project management skills, with the ability to lead and prioritize multiple projects simultaneously in a fast-paced environment
  • Excellent written and verbal communication and presentation skills, with the ability to convey technical concepts to non-technical stakeholders
  • Comfortable reading academic research papers and applying them in the models

Licensure and Certification:
  • None

Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Up to 15% (occasional) travel to attend meetings, trainings, and conferences may be required

Compensation Range:
$94,100.00 - $164,800.00
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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