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Remote Risk Adjustment Coder Jobs in Dayton, OH (NOW HIRING)

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 ...

Booz Allen Hamilton, Inc.

Data Analyst

Dayton, OH · On-site +1

$61K - $141K/yr

Remote Work: No Job Number: R0241818 Location: Dayton,OH,US Share job via: Share Data Analyst The ... Support the sustainment of risk scoring tools and other data analysis implementations by ...

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

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 ...

All JobsRisk Adjustment Coder JobsRemote Risk Adjustment Coder JobsRemote Risk Adjustment Coder Jobs in Dayton, OH

Remote Risk Adjustment Coder information

See Dayton, OH salary details

$15

$26

$42

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

As of Aug 26, 2026, the average hourly pay for remote risk adjustment coder in Dayton, OH is $26.72, according to ZipRecruiter salary data. Most workers in this role earn between $18.46 and $33.65 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.

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Remote Risk Adjustment Coder jobs near you
Infographic showing various Remote Risk Adjustment Coder job openings in Dayton, OH as of August 2026, with employment types broken down into 70% Full Time, 8% Part Time, 4% Temporary, and 18% Contract. Highlights an 22% In-person, and 78% Remote job distribution, with an average salary of $55,579 per year, or $26.7 per hour.

Director, Model Engineering & Operations

Dayton, OH • On-site, Remote

CareSource
Insurance Services • 1 - 5K employees

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

206th of 312 rated insurance

Good employer

Good schedule notice

Paid breaks

Learn more about CareSourceexternal

Full-time

Posted 21 days ago

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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