ZipRecruiter

Log In

2

Remote Risk Adjustment Coder Jobs in Pleasanton, CA

Trajectory Revenue Cycle Services

Medical Coder

Tracy, CA · On-site +1

$20.25 - $27/hr

Position Overview We are seeking a meticulous and detail-oriented Medical Coder specializing in ... Vision insurance This is a remote position. **Applicants must be legally authorized to work in the ...

MedHQ, LLC

Medical Coder

Tracy, CA · Remote

$19.25 - $25.50/hr

Position Overview We are seeking a meticulous and detail-oriented Medical Coder specializing in ... Vision insurance This is a remote position. **Applicants must be legally authorized to work in the ...

UnitedHealth Group

Medical Coder - RAD-ONC

Walnut Creek, CA · Remote

$20.38 - $36.44/hr

Generates coding queries for clarification regarding physician documentation as needed * Stays abreast of all changes in coding conventions and coding updates * Ability to manage significant workload ...

CENTRL

Software Engineer (Remote)

Mountain View, CA · Remote

CENTRL is a leading risk and compliance technology company that provides AI powered enterprise ... Experience coding with Java and Python; Front-end experience with Angular. * Experience with AI ...

next page

Showing results 1-20

People also search for

All JobsRemote Risk Adjustment Coder JobsRemote Risk Adjustment Coder Jobs in Pleasanton, CA

Remote Risk Adjustment Coder information

See Pleasanton, CA salary details

$17

$30

$48

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

As of May 29, 2026, the average hourly pay for remote risk adjustment coder in Pleasanton, CA is $30.60, according to ZipRecruiter salary data. Most workers in this role earn between $21.15 and $38.51 per hour, depending on experience, location, and employer.

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, 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 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 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.

More about Remote Risk Adjustment Coder jobs
What are popular job titles related to Remote Risk Adjustment Coder jobs in Pleasanton, CA? For Remote Risk Adjustment Coder jobs in Pleasanton, CA, the most frequently searched job titles are:
What cities near Pleasanton, CA are hiring for Remote Risk Adjustment Coder jobs? Cities near Pleasanton, CA 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 Pleasanton, CA as of May 2026, with employment types broken down into 63% Full Time, 33% Part Time, and 4% Contract. Highlights an 7% Physical, and 93% Remote job distribution, with an average salary of $63,638 per year, or $30.6 per hour.
Coding & Risk Adjustment Specialist - Clinical Operations

Coding & Risk Adjustment Specialist - Clinical Operations

Avail Health

Danville, CA • On-site, Remote

$40.75 - $54.75/hr

Contractor

Posted 4 days ago

Job description

Company Information
Avail Health
Reports to: VP of Operations, with close operational partnership alongside the VP of Care delivery and collaboration across operational leadership teams supporting alignment across Avail Health care programs.
FLSA Status: 1099, (Contract) / Part Time
Engagement Details: Fully remote/work from home supporting a fully distributed team across the US. This is a fractional / part-time independent contractor (1099) engagement. Hours and scope are flexible and will be defined collaboratively based on Avail Health's program needs. Anticipated commitment ranges from 5 to 20 hours per week depending on program maturity, project phases, and organizational priorities. Compensation will be commensurate with experience and engagement scope.
About Avail Health
Avail Health is a Nurse Practitioner-founded organization dedicated to removing barriers to care, access, and meaningful clinical work for Medicare-age individuals. We combine thoughtful technology, strong operational infrastructure, and deep respect for the patient-provider relationship to enable nurse-led virtual and mobile care models. As a fast-growing organization, we are building durable clinical infrastructure to support innovative care programs across multiple states, with a focus on improving outcomes for complex and underserved senior populations.
Role Summary
Avail Health is a rapidly growing value-based care company delivering comprehensive, technology-enabled care programs to Medicare patients with complex medical, behavioral health, and social needs. Our care model spans a range of clinical programs including Comprehensive Diagnostic Assessments (CDAs), Health Risk Assessments (HRAs), and Integrated Care Programs (ICPs), all designed to address the whole-person needs of high-risk Medicare beneficiaries.
As Avail Health continues to scale its clinical programs, we are seeking an experienced Risk Adjustment & Coding Expert to serve as a trusted fractional advisor to our clinical and operational leadership team. This role sits at the intersection of clinical documentation, Medicare coding compliance, and program-level performance-supporting our mission to deliver high-quality, accurately documented care that reflects the true complexity of our patient population.
The Risk Adjustment & Coding Expert will advise clinical leaders on proper HCC (Hierarchical Condition Category) coding practices, ensure documentation integrity across Avail's care programs, and drive ongoing workflow design, policy development, and process improvement to support accurate and compliant risk adjustment coding. This individual will function as a subject-matter expert embedded within Avail's interdisciplinary team structure, working collaboratively with Nurse Practitioners, Physicians, RN Care Managers, and operational leadership.
This is a startup-style healthcare environment where subject-matter experts are expected to be hands-on, pragmatic, and solutions-oriented. The ideal candidate brings deep Medicare Advantage risk adjustment expertise, strong knowledge of CMS coding guidelines, and a track record of building scalable coding education and quality programs within complex care or value-based care organizations.
Location & Work Environment
This position is primarily remote/work from home with regular collaboration across virtual interdisciplinary workflows.
Key Responsibilities
Clinical Advisory & HCC Coding Guidance
  • Performs audits on existing coding staff
  • Serve as the primary coding and risk adjustment subject-matter expert for Avail Health clinical leaders and frontline clinicians across CDAs, HRAs, and ICPs.
  • Advise Nurse Practitioners, Physicians, and RN Care Managers on accurate ICD-10-CM coding, HCC capture, and documentation requirements to support proper Medicare risk adjustment.
  • Review clinical encounter documentation and provide real-time feedback on coding accuracy, specificity, and completeness.
  • Identify coding gaps, missed HCC capture opportunities, and documentation deficiencies across care programs and patient populations.
  • Provide guidance on condition-specific coding requirements for high-prevalence chronic conditions within Avail's patient population (e.g., diabetes, CHF, COPD, CKD, behavioral health diagnoses).

Workflow Design & Policy Development
  • Partner with clinical and operational leadership to design and implement coding workflows integrated into Avail's care program delivery model.
  • Develop and maintain coding and documentation policies, guidelines, and standard operating procedures (SOPs) aligned with CMS requirements and Medicare Advantage risk adjustment best practices.
  • Support the development of documentation templates, encounter coding checklists, and structured data capture tools within the EMR and care coordination platforms.
  • Define escalation pathways and quality review workflows for coding discrepancies, queries, and corrections.

Education, Training & Provider Support
  • Design and deliver ongoing coding education and training programs for Avail's clinical team, including onboarding content for new clinicians and refresher training for existing staff.
  • Develop program-specific coding guides, quick-reference tools, and clinical documentation resources for CDAs, HRAs, and ICPs.
  • Partner with the VP of Care Delivery and Medical Director to integrate coding best practices into clinical workflows, quality reviews, and care team huddles.
  • Support providers in navigating complex coding scenarios including dual diagnoses, behavioral health coding, and social determinants of health (SDOH) documentation.

Quality, Compliance & Process Improvement
  • Conduct coding audits and documentation reviews across a sample of clinical encounters to assess coding accuracy, completeness, and compliance with CMS and Medicare Advantage plan requirements.
  • Track and report on coding quality metrics, HCC capture rates, and risk adjustment performance trends to clinical and operational leadership.
  • Identify opportunities for process improvement related to risk adjustment documentation and coding workflows, and lead structured improvement initiatives.
  • Stay current on CMS HCC model updates, Medicare Advantage coding guidelines, and regulatory changes affecting risk adjustment; proactively communicate relevant changes to the team.
  • Support preparation for coding audits, RADV (Risk Adjustment Data Validation) reviews, and compliance activities as needed.

Program-Level Support Across CDAs, HRAs & ICPs
  • Provide targeted coding and documentation guidance specific to the clinical workflows and patient populations within each of Avail's core care programs.
  • Support alignment between CDA, HRA, and ICP documentation requirements and risk adjustment coding capture to ensure program integrity and compliance.
  • Collaborate with care program managers and clinical leads to embed coding best practices into program design, clinician onboarding, and ongoing quality oversight.

Preferred Characteristics
  • Deep subject-matter expertise combined with a practical, hands-on approach to implementation.
  • Strong clinical communication skills-comfortable translating complex coding requirements into actionable guidance for busy clinicians.
  • Collaborative and consultative by nature; able to build trust quickly with clinical and operational leaders.
  • Solutions-oriented and comfortable operating in ambiguous, fast-paced startup environments.
  • Highly organized with strong follow-through and the ability to manage multiple priorities across program areas.
  • Committed to compliance, accuracy, and program integrity without creating unnecessary friction in clinical workflows.
  • Passion for improving care delivery for complex, high-risk Medicare populations.

Qualifications
  • Must have Certified Risk Adjustment Coder (CRC); Certified Professional Coder (CPC) also highly desirable
  • Minimum 5 years of experience in Medicare risk adjustment coding, HCC coding, or clinical documentation improvement (CDI) required.
  • Deep knowledge of ICD-10-CM coding guidelines, CMS HCC models (V24, V28), and Medicare Advantage risk adjustment methodology.
  • Experience working in value-based care, Medicare Advantage, population health, or complex care management environments strongly preferred.
  • Prior experience advising clinical providers (NPs, MDs, RN Care Managers) on coding and documentation practices.
  • Experience designing or delivering coding education and training programs for clinical teams.
  • Familiarity with CDAs, HRAs, Annual Wellness Visits (AWVs), and Transitional Care Management (TCM) coding preferred.
  • Experience with RADV audits, coding compliance programs, and risk adjustment quality initiatives preferred.
  • Proficiency with EMR platforms, coding tools, and documentation review workflows.
  • Ability to work independently in a fractional/part-time capacity with strong self-direction and accountability.

Apply