ZipRecruiter

Log In

2

Remote Risk Adjustment Coder Jobs in Philadelphia, PA

Berkley

Claims Analyst

Trenton, NJ · Remote

$70K - $80K/yr

Company Details Berkley Accident and Health is a risk management company that designs innovative ... This position can either be fully remote (if not within commutable distance to the office) or based ...

RELX

Senior Technical Consultant

Philadelphia, PA · Remote

$114K - $190K/yr

About LexisNexis Risk Solutions LexisNexis Risk Solutions harnesses the power of data ... Occasional travel may be required Location Remote - US Requirements * Minimum 5 years of total ...

L3HHCM20

Senior Specialist, Subcontracts

Trenton, NJ · Remote

$91K - $170K/yr

Job Title: Senior Specialist, Subcontracts (Remote) Job Code: 40138 Job Location: Remote ... Risk Identification and Mitigation: Identify potential risks associated with subcontracting ...

Corvel

Senior Claims Specialist

Norristown, PA · Remote

$61K - $98K/yr

This role is available for both remote and hybrid work arrangements. ESSENTIAL FUNCTIONS ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Certa

Engagement Manager

Wilmington, DE · Remote

... code platform to onboard, assess, and monitor their vendors, suppliers, and partners across risk ... Certa is a remote-first company and we hire globally. We believe strongly in each team member ...

BAI

Software Engineer

Philadelphia, PA · On-site +1

$75K - $95K/yr

... risk management functions and BAI's knowledge in serving the retail banking and regulatory ... Participate in code reviews, technical guidance, and knowledge sharing. * Participate in efforts to ...

next page

Showing results 1-20

All JobsRisk Adjustment Coder JobsRemote Risk Adjustment Coder JobsRemote Risk Adjustment Coder Jobs in Philadelphia, PA

Remote Risk Adjustment Coder information

See Philadelphia, PA salary details

$16

$27

$43

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

As of Jul 21, 2026, the average hourly pay for remote risk adjustment coder in Philadelphia, PA is $27.74, according to ZipRecruiter salary data. Most workers in this role earn between $19.18 and $34.95 per hour, depending on experience, location, and employer.

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

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 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 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.

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 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.

More about Remote Risk Adjustment Coder jobs
What are the most commonly searched types of Risk Adjustment Coder jobs in Philadelphia, PA? The most popular types of Risk Adjustment Coder jobs in Philadelphia, PA are:
What are popular job titles related to Remote Risk Adjustment Coder jobs in Philadelphia, PA? For Remote Risk Adjustment Coder jobs in Philadelphia, PA, the most frequently searched job titles are:
What job categories do people searching Remote Risk Adjustment Coder jobs in Philadelphia, PA look for? The top searched job categories for Remote Risk Adjustment Coder jobs in Philadelphia, PA are:
What cities near Philadelphia, PA are hiring for Remote Risk Adjustment Coder jobs? Cities near Philadelphia, PA with the most Remote Risk Adjustment Coder job openings:
Remote Risk Adjustment Coder jobs near you
Claims Analyst

Claims Analyst

Berkley

Trenton, NJ • Remote

$70K - $80K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 15 days ago

Job description

Company Details

Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk - our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.

#LI-AV1  #LI-Remote

The company is an equal employment opportunity employer.

Responsibilities

As a Stop Loss Claims Auditor (a.k.a. "Claims Analyst"),  you'll perform quality review and evaluation of all claim submissions received and logged into our claims system to determine whether the amount requested is eligible for reimbursement.

This position can either be fully remote (if not within commutable distance to the office) or based in one of our offices:

  • Hamilton Square, NJ
  • West Hartford, CT
  • Marlborough, MA
  • Harleysville, PA

We offer hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.

What you can expect:

  • Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent
  • Internal mobility opportunities 
  • Visibility to senior leaders and partnership with cross functional teams
  • Opportunity to impact change
  • Benefits - competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education

We'll count on you to: 

  • Process an average of 5 to 7 claims per day
  • Maintain a processing accuracy of 99% or better
  • Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
  • Review and adjudicate claims within approved authority limits
  • Maintain assigned claim block and assist other team members while meeting departmental guidelines
  • Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.
  • Elevate issues to next level of supervision, as appropriate
  • Other duties as assigned
Qualifications

What you need to have:

  • 3-5+ years stop loss claims experience
  • Prior experience handling first dollar payer insurance (medical healthcare claims)
  • Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing
  • Ability to use mathematics to adjudicate claims
  • Detail oriented with a high degree of accuracy and ability to multitask
  • Strong problem solving, decision-making, reporting and analytical skills
  • Must possess good judgment and work effectively with internal business areas, peers and co-workers
  • Demonstrated proficiency in Microsoft Office software 

What makes you stand out:

  • Prior experience handling stop loss claims at the reinsurance level (medical healthcare claims)
  • Ability to work independently, prioritize, organize and assign own work to meet deadlines
  • Ability to accept changing priorities with a minimum of disruption
Additional Company DetailsWe do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including: Base Salary Range: $70,000 - $80,000 Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and generous profit-sharing plan The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.Sponsorship DetailsSponsorship not Offered for this RoleEmployment Type: OTHER

Apply