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Remote Risk Adjustment Coder Jobs in Rochester, PA

The LaSalle Group

Inpatient Coder

Pittsburgh, PA · Remote

$38 - $40/hr

We're looking for an experienced Inpatient Coder to step into a fully remote role where your expertise actually matters. This Inpatient Coder position is designed for professionals who have worked in ...

Highmark Health

Lead Client Manager - PA

Pittsburgh, PA · On-site +1

$144K/yr

This role can be hybrid or remote. If you are within 50 miles of an office you are required to be ... Complete and maintain sales projections, finalize rates and benefit adjustments and prepare reports ...

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$14

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$39

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

As of Jun 1, 2026, the average hourly pay for remote risk adjustment coder in Rochester, PA is $24.91, according to ZipRecruiter salary data. Most workers in this role earn between $17.21 and $31.35 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 cities near Rochester, PA are hiring for Remote Risk Adjustment Coder jobs? Cities near Rochester, PA with the most Remote Risk Adjustment Coder job openings:
Remote Risk Adjustment Coder jobs near you
Advanced Practice Provider - Pittsburgh, PA

Advanced Practice Provider - Pittsburgh, PA

Highmark Health

Pittsburgh, PA • On-site, Remote

$107.30K - $120.40K/yr

Full-time

Posted 9 days ago

Highmark Health rating

7.8

Company rating: 7.8 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

Job description

Company :
EndorsedJob Description :
JOB SUMMARY
This is a full-time community-based position requiring frequent travel within the assigned territory in Pittsburgh, PA. A significant portion of this role involves conducting comprehensive health risk assessments directly with members in their homes.
This role is integral to the organization's comprehensive care delivery system. The incumbent delivers high-quality, patient-centered care through in-home, virtual, and telephonic comprehensive clinical assessments for members with chronic health conditions. This autonomous position provides holistic, community-based care, especially for geriatric and palliative populations. The role proactively manages symptoms, guides advance care planning, and supports members with chronic or life-limiting illnesses to ensure optimal quality of life and health outcomes. The role involves accurately identifying and documenting all active chronic medical conditions essential for risk adjustment.
ESSENTIAL RESPONSIBILITIES
  • Comprehensive Clinical Assessments: Conduct comprehensive in-home, video, and telephonic clinical assessments, including detailed histories, physical examinations, and identification of all active diagnoses, symptoms, functional status, and social determinants of health.
  • Diagnostic Interpretation & Treatment Planning: Order and interpret laboratory, radiological, and other diagnostic studies, then make medical diagnoses and institute appropriate therapy within applicable scope and standards of practice.
  • Palliative Care & Symptom Management: Manage medications and treatments related to palliative care, alleviating pain and other distressing symptoms related to life-limiting illnesses.
  • Patient & Family Guidance: Provide emotional and psychological support, and educate patients and families about illness progression, treatment options, and aligning to goals of care.
  • Advance Care Planning: Facilitate advance care planning conversations and end-of-life discussions.
  • Collaborative Care Coordination: Collaborate and coordinate care with other providers active on the patient's care team and participate in interdisciplinary team meetings to review and update patient care plans.
  • Emergency Intervention: Institute emergency measures or appropriate stabilization for acute patient situations.
  • EMR & Risk Adjustment Documentation: Utilize electronic medical record (EMR) systems for thorough and compliant clinical documentation, ensuring timely and accurate record of pertinent information to support comprehensive medical coding and risk adjustment methodologies.
  • Reporting & Communication: Identify and inform the attending physician of record of all significant changes to the patient's ongoing condition in a timely manner.
  • Professional Development & Compliance: Maintain mandatory professional continuing education and uphold professional practice consistent with organizational statements and medical staff compliance.
  • Other duties as assigned or requested.

EDUCATION
Required
  • Graduate from an accredited PA program OR Graduate from a Nursing Approved Master's or Post Master's program

Substitutions
  • None

Preferred
  • Board certification or clinical experience in a relevant specialty (e.g., Family Medicine, Internal Medicine, Geriatrics, Hospice or Palliative Care).

EXPERIENCE
Required
  • 3 years of clinical experience as an NP or PA, preferably in primary care, geriatrics, palliative or hospice care, chronic disease management, home health, or a similar community-based setting.

Preferred
  • Previous experience conducting in-home assessments or house calls.
  • Knowledge of CMS regulations and guidelines.
  • Experience in population health management.

LICENSES or CERTIFICATIONS
Required
  • CPR Certification
  • Current Physician Assistant License OR Current State of PA RN licensure or Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) + CRNP license and Prescriptive Authority in the State of PA.
  • Valid driver's license and reliable transportation with appropriate insurance coverage to travel to patient homes across designated service areas.

Preferred
  • DEA controlled substances license

SKILLS
  • Patient & Family Engagement: Exceptional communication, motivational interviewing and empathy skills for patient-centered care, sensitive health discussions, and effective education for diverse patient populations.
  • Clinical Acumen & Care Planning: Expertise in critical clinical assessment and the ability to identify and address patient care gaps, opportunities for health improvement and formulate care plans including advance care planning.
  • Interpersonal & Team Collaboration: Exceptional interpersonal and communication skills to build rapport and effectively collaborate with internal and external care teams.
  • Autonomous Work & Caseload Management: Demonstrated ability to work autonomously and manage an effective caseload in a community-based or home care setting.
  • Organizational & Time Management: Excellent organizational and time management skills to efficiently conduct multiple visits daily and complete documentation.
  • Problem-Solving & Adaptability: Strong problem-solving skills and the ability to adapt to unexpected situations in the field.
  • Technological Fluency: Proficient with EMR systems, portable diagnostic equipment, mobile technology, and standard computer applications including Microsoft Office products.
  • Continuous Learning: Commitment to continuous learning and professional development, particularly in palliative care, geriatrics, risk adjustment, and clinical guidelines.
  • Risk Adjustment & Documentation Acumen: Strong knowledge of risk adjustment methodologies and coding principles, coupled with the ability to ensure documentation integrity for compliant medical coding.
  • High-Performing Team Integration: Ability to work effectively in a flexible, high-performing team environment.

Language (Other than English):
None
Travel Requirement:
50% - 75%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Never
Exposure to Blood, body fluids or tissue
Occasionally
Exposure to needles or sharps
Occasionally
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$102,700.00
Pay Range Maximum:
$164,600.00
Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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About Highmark Health

Sourced by ZipRecruiter

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2022 consolidated revenues totaling $26 billion. And we're proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

Industry

Health care and social assistance and insurance services

Company size

10,000+ Employees

Headquarters location

Pittsburgh, PA, US

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