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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 ...

Network Optix

Sales Operations Specialist

Walnut Creek, CA · On-site

$86K - $126K/yr

... or at-risk items to senior team members. What you'll be doing Billing & Revenue Operations ... Collaborate with the Accounting team on credits and customer account adjustments, ensuring proper ...

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 ...

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Remote Risk Adjustment Coder information

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

As of Jun 25, 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 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
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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
Staff Data Scientist (SME: Healthcare Financial Risk & Underwriting)

Staff Data Scientist (SME: Healthcare Financial Risk & Underwriting)

Prealize Health

San Jose, CA • Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 22 days ago

Job description

Staff Data Scientist (SME: Healthcare Financial Risk & Underwriting)
About Prealize Health
Prealize Health is a predictive analytics company that leverages machine learning and clinical expertise to help patients obtain better care, sooner. Most healthcare today is reactive – care is delivered when someone is already ill. We believe healthcare should be about keeping individuals and their families well to prevent them from ever becoming sick.
Building on years of published research from our founders at Stanford University, our mission is to provide patients, providers, and payers with the insights they need to improve health outcomes and prevent adverse medical events. We are committed to helping healthcare organizations "see around the corner" to take a proactive approach to wellness.
The Role
As a Staff Data Scientist and the primary SME for Healthcare Financial Risk & Underwriting, you will serve as the technical authority for our most critical Healthcare financial risk and underwriting modeling domains. You will bridge the gap between complex actuarial needs and cutting-edge machine learning, defining the technical roadmap to scale predictive models for risk adjustment and underwriting.
This is a strategic, high-impact role where you will lead the evolution of our predictive models, shaping how we evaluate and power the next generation of our underwriting product.
Key Responsibilities
  • Domain Expertise: Act as the Subject Matter Expert (SME), drive the end-to-end building and execution of our Risk & Underwriting AI models, directly translating actuarial and healthcare financial risk expertise into high-performance AI models and rigorous evaluation frameworks.
  • Strategic Vision: Set the technical roadmap and lead the development of ML models focused on healthcare financial risk stratification and financial underwriting.
  • Methodological Excellence: Establish best practices for model building, model validation, and rigorous back testing/benchmarking across the data science organization to drive high performance models, while maintaining stability and alignment of models.
  • Technical Leadership: Mentor junior data scientists, fostering a culture of rigorous research, high-quality engineering, and innovation.
  • Cross-Functional Collaboration: Partner with clinicians to translate medical knowledge into data-driven hypotheses and with Product/Executive teams to align technical capabilities with market opportunities.
  • Platform Innovation: Work with Engineering to design the next generation of our platform’s quality and extensibility, ensuring it remains performant for millions of patients.
  • External Evangelism: Represent Prealize Health’s technical expertise to external strategic partners and stay at the forefront of literature in ML, Actuarial Science, and Biostatistics.

Required Qualifications
  • Education: PhD and/or MS in Statistics, Biostatistics, Economics, Computer Science, or a related quantitative field.
  • Experience: 8–10+ years of experience building and deploying commercial-grade data science products with a proven track record of technical leadership.
  • Domain Expertise: Deep experience building and validating models for healthcare underwriting use cases. Mastery of industry-standard risk scores and large-scale claims data is mandatory.
  • Programming & AI Tooling: Expert proficiency in Python and distributed computing (PySpark/Spark/SQL).
  • Proficiency in leveraging AI-assisted coding tools (e.g., Claude Code, Cursor, Codex) to accelerate development cycles and enhance code quality.
  • Statistical Rigor: Expert-level understanding of model evaluation metrics (e.g., Gini, lift, calibration), back testing frameworks, and validation protocols for high-stakes predictive modeling.
  • Strategic Mindset: Demonstrated ability to lead cross-functional projects, influence technical roadmaps, and solve high-ambiguity problems in high-dimensional datasets.
  • Communication: Exceptional ability to distill complex technical strategies for executive stakeholders and external partners.

Preferred Skills
  • Deep Learning Expertise: Mastery of transformer architectures, attention mechanisms, and pre-training/fine-tuning paradigms. Hands-on experience with PyTorch or TensorFlow is preferred.
We Offer:
  • Flexible work environment
  • Competitive base salary plus a generous bonus and equity plan
  • Paid time off including holidays
  • Medical, dental, vision
  • 401k
  • Wellness and home office benefits, and more

Pay Transparency:
The target salary range is $160,000 to $190,000 annually. Base pay offered may vary within the posted range based on several factors, including but not limited to education, job-related knowledge, skills, experience, and location.
Diversity, Equity & Inclusion:
Prealize embraces diversity and equal opportunity in a serious way. We are committed to building a team that unites a variety of backgrounds, perspectives, and skills. The more inclusive we are, the greater our impact will be.

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