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Remote Risk Adjustment Coder Jobs in Pennsylvania

Solventum

CDI Product Manager

Pittsburgh, PA · On-site +1

Strong knowledge of outpatient CDI, ICD-10-CM coding, HCC risk adjustment, quality risk ... Remote Travel: May include up to 10% Relocation Assistance: Not authorized Must be legally ...

Premier Orthopaedics

Coder II - Remote

King Of Prussia, PA · On-site +1

$18.25 - $24.50/hr

Coder II Location: Remote Organization: Premier Orthopaedics, in partnership with Philadelphia Hand to Shoulder Overview Premier Orthopaedics, in partnership with Philadelphia Hand to Shoulder, is ...

YO AI Labs

Medical Coder - Remote

Philadelphia, PA · Remote

$50 - $80/hr

Medical Coder Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Coders to contribute their healthcare coding expertise to an innovative project focused on ...

Premier Orthopaedics

Coder I - Remote

West Chester, PA · On-site +1

$17.75 - $23.75/hr

Coder I Location: Remote Organization: Premier Orthopaedics, in partnership with Philadelphia Hand to Shoulder Overview Premier Orthopaedics, in partnership with Philadelphia Hand to Shoulder, is ...

DaVita

Manager, Nurse Practitioner (IKC)

Bernville, PA · On-site +1

... remote role! Candidate must live in CST or EST. DaVita is seeking a full-time Nurse Practitioner ... Experience with Medicare Advantage risk adjustment, documentation, coding, and Health Risk ...

Clark Associates

Director of Risk

Lancaster, PA · On-site +1

... adjustments. * Oversee reserving practices, claim strategies, and root-cause assessments. Risk ... Remote Work Qualifications * Access to a reliable and secure high-speed internet connection. Cable ...

Solventum

CDI Growth Manager

Pittsburgh, PA · On-site +1

... coding practices, quality measures, risk adjustment, reimbursement optimization, regulatory ... Work Location - Remote Travel - upto 50% Relocation Assistance - Not Authorized Work Authorization ...

Healthcare

CDI Growth Manager

Pittsburgh, PA · Remote

... coding practices, quality measures, risk adjustment, reimbursement optimization, regulatory ... Work Location - Remote Travel - upto 50% Relocation Assistance - Not Authorized Work Authorization ...

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Remote Risk Adjustment Coder information

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$15

$27

$43

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

As of Sep 2, 2026, the average hourly pay for remote risk adjustment coder in Pennsylvania is $27.56, according to ZipRecruiter salary data. Most workers in this role earn between $19.04 and $34.71 per hour, depending on experience, location, and employer.

What is a remote risk adjustment coder?

A Remote Risk Adjustment Coder is a healthcare professional who reviews patient medical records and assigns diagnostic codes from a remote location, typically from home. Their primary goal is to ensure accurate coding for risk adjustment purposes, which helps health plans predict patient healthcare costs and receive appropriate funding. These coders work with electronic health records and must be knowledgeable about coding standards like ICD-10-CM. They play a key role in supporting compliance and maximizing revenue for healthcare organizations. Attention to detail, confidentiality, and proficiency with coding software are essential skills for this remote position.

What does a remote risk adjustment coder do?

As a remote risk adjustment coder, your duties and responsibilities involve performing medical coding and reviewing medical codes for adherence to risk adjustment models. Employers may also expect you to audit medical record data to ensure accuracy. In this role, you work from home to apply codes and make assessments according to regulations and your employer’s operational policies. You also report the results of an audit to the relevant supervisor or coding service provider. It’s your job to ensure compliance with rules related to patient privacy and electronic medical record keeping.

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

To thrive as a Remote Risk Adjustment Coder, you need a solid understanding of ICD-10-CM coding, medical terminology, and risk adjustment models, often supported by a coding certification such as CPC, CRC, or CCS. Proficiency with electronic health record (EHR) systems, coding software, and data management tools is essential. Attention to detail, strong analytical skills, and effective communication are crucial soft skills for accurate code assignment and collaboration with healthcare teams. These skills ensure compliance, maximize reimbursement, and support quality healthcare outcomes in a remote environment.

What are the common challenges faced by remote risk adjustment coders and how can they be managed?

Remote Risk Adjustment Coders often encounter challenges such as interpreting complex medical records, ensuring coding accuracy under tight deadlines, and staying updated with evolving coding guidelines. Managing these challenges typically involves strong attention to detail, proactive communication with team members, and participating in ongoing training sessions or webinars. Utilizing supportive resources and adhering to standardized coding protocols can help coders maintain accuracy and efficiency in a remote setting.

What is the difference between Remote Risk Adjustment Coder vs Remote Medical Coder?

AspectRemote Risk Adjustment CoderRemote Medical Coder
CertificationsAHIMA or AAPC Risk Adjustment certificationsAAPC CPC, CCS, or RHIT certifications
Work EnvironmentHealthcare insurance, payer organizations, risk adjustment teamsHospitals, clinics, physician offices, insurance companies
Industry UsagePrimarily in health insurance and risk adjustment programsBroad healthcare settings including hospitals and outpatient clinics

Remote Risk Adjustment Coders focus on analyzing patient data for insurance risk models, requiring specific risk adjustment certifications. Remote Medical Coders handle a wider range of medical records coding across various healthcare settings. While both roles involve medical coding, their industries, certifications, and primary tasks differ significantly.

More about Remote Risk Adjustment Coder jobs

What are the most commonly searched types of Risk Adjustment Coder jobs in Pennsylvania?

The most popular types of Risk Adjustment Coder jobs in Pennsylvania are:

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For Remote Risk Adjustment Coder jobs in Pennsylvania, the most frequently searched job titles are:

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The top searched job categories for Remote Risk Adjustment Coder jobs in Pennsylvania are:

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Cities in Pennsylvania with the most Remote Risk Adjustment Coder job openings:

Remote Risk Adjustment Coder jobs near you
Infographic showing various Remote Risk Adjustment Coder job openings in Pennsylvania as of August 2026, with employment types broken down into 82% Full Time, 12% Part Time, 3% Temporary, and 3% Contract. Highlights an 100% Remote job distribution, with an average salary of $57,319 per year, or $27.6 per hour.

Manager, Risk Adjustment Operations

Capital Blue Cross

Harrisburg, PA • On-site, Remote

$86K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 11 days ago

Capital Blue Cross rating

7.7

Company rating: 7.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

210th of 315 rated insurance

Job description

Position Description
Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA."
The Manager, Risk Adjustment Operations provides end-to-end operational management, delivery and support to new and existing MA and ACA Risk Adjustment Programs. Working closely with the Director, Risk Adjustment Programs, this position drives execution of operational priorities, manages program performance, and ensures timely delivery of strategic initiatives through data-driven decision making, cross-functional coordination, and operational accountability. The manager will be responsible for professional coaching and mentoring of program team members while fostering continuous process improvement.
Responsibilities and Qualifications
  • Drive day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives, ensuring project milestones, regulatory deadlines, and operational deliverables are completed on schedule.
  • Develop and maintain integrated project plans, operational calendars, risk logs, and status reporting to support successful program execution.
  • Monitor program performance through dashboards, KPIs, and operational metrics; identify trends, escalate risks, and recommend data-driven improvements.
  • Coordinate cross-functional activities across Analytics, Coding, Provider Engagement, Chart Retrieval, Actuarial, Compliance and vendor partners to ensure successful execution of operational priorities.
  • Hold internal teams and external vendors accountable for operational performance, deliverables, timelines, service level expectations, and issue resolution.
  • Proactively identify operational barriers and develop mitigation plans to minimize impact to program performance.
  • Strategic vision to align business operations with broader organizational goals.
  • Business acumen to drive growth and success through data-driven decisions.
  • Lead operational vendor onboarding and offboarding activities, support vendor evaluations and RFP processes, and partner with procurement and other stakeholders to ensure successful implementation and ongoing operational performance.

Skills:
  • Strong verbal and written communication skills, including the ability to communicate complex operational issues clearly to business partners and leadership.
  • Strong organizational and project management skills, with demonstrated ability to manage multiple priorities, deadlines, dependencies, and deliverables.
  • Ability to lead cross-functional initiatives and build effective working relationships across internal departments and external vendor partners.
  • Strong analytical and problem-solving skills, including demonstrated ability to interpret dashboards, key performance indicators, and operational reporting to monitor performance, identify risks, and drive operational decision-making.
  • Strong business acumen, including the ability to understand operational, financial, contractual, and regulatory considerations.
  • Ability to proactively identify risks, remove barriers, develop mitigation plans, and escalate issues appropriately.
  • Strong vendor management skills, including experience in supporting vendor evaluation, onboarding, implementation, performance monitoring, and transitions.
  • Ability to work independently, exercise sound judgement, and drive accountability in a fast-paced, deadline-oriented environment.
  • Proficiency with Microsoft Office applications, including advanced Excel skills; ability to interpret and leverage Power BI or other business intelligence reporting preferred.

Knowledge:
  • Working knowledge of Medicare Advantage and ACA Risk Adjustment regulations and payment methodologies.
  • Working knowledge of industry standards and best practices for Risk Adjustment operations.
  • Working knowledge of cross-functional Risk Adjustment operational processes, including provider engagement, analytics, coding, vendor management, and regulatory compliance.

Experience:
  • 5 years of Operations and/or Program management.
  • 3 years of Risk Adjustment Operations or Program Management.
  • Experience leading complex, cross-functional operational initiatives involving multiple stakeholders and competing priorities.
  • Experience supporting vendor selection, RFP processes, business requirements, Statement of Work (SOWs), implementation, onboarding, and ongoing vendor performance management.
  • Experience monitoring operational performance and driving execution to meet regulatory deadlines and business objectives.
  • 1 year staff, team lead or project lead experience.
  • Experience supervising staff and provider operational leadership across cross-functional programs or initiatives preferred.

Education and Certifications:
  • Bachelor's degree in business administration, Healthcare Administration, Public Health, Health Information Management, Finance, Economics or 9 years relevant and progressive experience in lieu of bachelor's degree.
  • Lean Six Sigma or other operational excellence/process improvement certification preferred.

Physical Demands:
  • While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
  • The employee must be able to work over 40 hours per week.
  • The employee must occasionally lift and/or move up to 5 pounds.

About Us
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.

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