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Remote Risk Adjustment Coding Jobs in Closter, NJ

eTeam

Medical Coder

Newark, NJ · Remote

$40 - $42/hr

Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports ...

EmblemHealth

Staff Actuary

New York, NY · Remote

REMOTE Summary of Position * Provide the analytical resources necessary for the development of ... Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs ...

EmblemHealth

Staff Actuary - Medicare

New York, NY · On-site +1

REMOTE Summary: * Provide the analytical resources necessary for the development of overall pricing ... Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs ...

EmblemHealth

Lead Audit Specialist - Remote

New York, NY · On-site +1

$77K - $149K/yr

... risk adjustment. Manage vendor relationships and contracts to ensure audit vendors follow best ... and reducing coding errors; manage efforts to enhance RADV audit coordination workflows.

Advanced Medical Management

Medical Assistant

New York, NY · Remote

$21 - $23/hr

... risk adjustment. Pre-Visit Planning • Prepare and maintain Pre-Visit Checklists for upcoming ... coding and compliance. VBC Screening & Quality Support • Proactively identify patients due for ...

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All JobsRemote Risk Adjustment Coding JobsRemote Risk Adjustment Coding Jobs in Closter, NJ

Remote Risk Adjustment Coding information

See Closter, NJ salary details

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$24

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

As of Jun 19, 2026, the average hourly pay for remote risk adjustment coding in Closter, NJ is $22.27, according to ZipRecruiter salary data. Most workers in this role earn between $18.65 and $23.65 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 medical coding, anatomy, and healthcare regulations, typically backed by a coding certification such as CPC, CRC, or CCS. Familiarity with coding software, electronic health record (EHR) systems, and risk adjustment models like HCC is essential. Attention to detail, critical thinking, and strong written communication are crucial soft skills for interpreting clinical documentation and ensuring coding accuracy. These skills and qualifications are vital to accurately capture patient risk, ensure compliance, and optimize reimbursement for healthcare organizations.

What is remote risk adjustment coding?

Remote risk adjustment coding is the process of reviewing and assigning medical codes to patient diagnoses and procedures from a remote location, usually at home. The purpose is to ensure that healthcare organizations accurately report the health status of their patients, which affects reimbursement from health plans. Coders use specialized knowledge of ICD-10-CM coding and risk adjustment models, such as HCC (Hierarchical Condition Category) coding, to capture all relevant chronic conditions. This position requires attention to detail, compliance with regulations, and strong analytical skills.

What is the difference between Remote Risk Adjustment Coding vs Remote Medical Coding?

AspectRemote Risk Adjustment CodingRemote Medical Coding
CertificationsRHIA, RHIT, CPC, CCSCPC, CCS, CCS-P
Work EnvironmentHealthcare organizations, insurance companiesHospitals, clinics, insurance companies
Industry UsageHealth insurance, risk adjustment programsMedical billing, claims processing

Remote Risk Adjustment Coding focuses on analyzing patient data for insurance risk assessments, requiring specific risk adjustment certifications. Remote Medical Coding involves coding diagnoses and procedures for billing purposes. While both roles require coding certifications, Risk Adjustment Coding emphasizes risk analysis within insurance, whereas Medical Coding centers on billing accuracy.

How does working remotely as a Risk Adjustment Coder impact collaboration with healthcare teams and ongoing professional development?

As a remote Risk Adjustment Coder, you'll often collaborate with clinical staff, auditors, and other coders through secure digital platforms and regular virtual meetings. While remote work offers flexibility, it also means that proactive communication is essential to ensure accurate coding and compliance with regulations. Many organizations provide virtual training sessions, access to coding forums, and ongoing education to help you stay updated on industry changes and coding standards. Building relationships with your team and participating in online professional communities can further support your growth and help overcome the isolation that sometimes comes with remote work.
What are popular job titles related to Remote Risk Adjustment Coding jobs in Closter, NJ? For Remote Risk Adjustment Coding jobs in Closter, NJ, the most frequently searched job titles are:
What cities near Closter, NJ are hiring for Remote Risk Adjustment Coding jobs? Cities near Closter, NJ with the most Remote Risk Adjustment Coding job openings:
Remote Risk Adjustment Coding jobs near you
Compliance Lead - RCM & Clinical Documentation (Clinical Background Required)

Compliance Lead - RCM & Clinical Documentation (Clinical Background Required)

Essen Medical Associates

Bronx, NY • On-site, Remote

$75K - $90K/yr

Full-time

Posted 8 days ago

Job description

Overview
Company Overview: At Essen Health Care, we care for that!
Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to some of the state's most vulnerable and underserved residents. Founded in 1999, we've grown to 50+ locations and 600+ providers delivering urgent care, primary care, specialty services, nursing home support, and in-home care - guided by a Population Health model across in-person, home, and telehealth settings.
Job Summary
Position Title: Operational Compliance Lead - RCM & Clinical Documentation (Clinical Background Required)
Reporting to: Chief Administrative Officer
Scope: Essen Health Care & Nursing Home Division only
Job Summary: The Operational Compliance Lead is an embedded, frontline role managing day-to-day RCM and clinical operations compliance within Essen Health Care and its Nursing Home division. This is a hands-on operational position - distinct from the corporate compliance function - focused on identifying, correcting, and monitoring coding and billing accuracy before issues escalate to external review. Drawing on a clinical background (IMG preferred) and coding expertise, this Lead works directly with administrative and clinical operations leaders to drive documentation integrity, prevent CMS or state audit exposure, and ensure the organization is always audit-ready.
Responsibilities
Operational Compliance & Chart Review
  • Conduct routine and targeted clinical chart reviews and RCM audits assessing coding accuracy, billing integrity, and documentation completeness across CMS and state-billed services.
  • Proactively monitor for compliance risk patterns; generate ongoing trend reports to flag issues before they escalate to external review.
  • Identify coding discrepancies and billing vulnerabilities with focus on ICD-10-CM, CPT, E&M level selection, and Medical Decision Making (MDM) accuracy.
  • Develop, own, and drive Corrective Action Plans (CAPs) to confirmed completion, including re-audit to validate sustained improvement.

Clinical Coding & RCM Collaboration
  • Apply clinical knowledge to review documentation with a clinician's lens - ensuring diagnoses, MDM, and services support the codes being billed.
  • Work directly with admin and clinical operations leaders on ICD-10-CM, CPT, E&M, HCPCS, and HCC/risk adjustment coding accuracy.
  • Serve as the operational compliance liaison to RCM - bridging clinical documentation, coding, and billing to ensure alignment and defensibility.

Provider & Leadership Education
  • Deliver targeted, clinically grounded education to physicians, NPs, PAs, and staff on documentation best practices and coding compliance.
  • Develop training content on coding standards and payer-specific regulatory requirements as guidelines evolve.

Reporting & CAP Management
  • Produce executive-ready compliance trend reports and audit summaries that inform leadership decisions and prioritize risk.
  • Present CAPs to clinical and administrative leadership with clear timelines, owners, and success metrics - then own follow-through to resolution.
  • Act as the first line of resolution before issues surface at the corporate compliance level; maintain continuous audit readiness.

Qualifications
Qualifications
Required
  • Bachelor's Degree in Healthcare Administration, Nursing, Health Information Management, Public Health, or related field.
  • Clinical background required; International Medical Graduate (IMG) or foreign medical degree highly valued.
  • Active coding certification: CPC, CRC, CCS, or equivalent.
  • Minimum 3 years of operational compliance, coding, clinical chart review, or RCM experience; demonstrated ability to develop and close out CAPs.
  • Strong knowledge of ICD-10-CM, CPT, HCPCS, HCC/Risk Adjustment, Medicare/Medicaid regulations, and HIPAA.
  • Demonstrated ability to present audit findings and CAPs to senior leadership; comfortable owning follow-through to resolution.

Preferred
  • Master's Degree (MHA, MPH, MBA with healthcare focus, MSN, or equivalent) - strongly preferred given the organizational complexity and cross-functional leadership demands of this role.
  • Project management experience or certification (PMP, CAPM, or equivalent).
  • Experience in Medicare Advantage, value-based care, and/or Clinical Documentation Improvement (CDI).
  • Experience with eClinicalWorks (eCW) or similar EMR systems.
  • Prior experience providing provider education and compliance training.

Core Competencies
Clinical Documentation Integrity • Compliance Auditing • RCM & Revenue Integrity • Provider Education & Coaching • HCC/Risk Adjustment Coding • CAP Development & Closure • Regulatory Compliance • Data Analysis & Reporting • Project Management • Cross-Functional Collaboration
Work Environment
  • Full-time | Hybrid or on-site based on business needs | Travel between clinical locations may be required.

Why Join Essen Health Care?
The Operational Compliance Lead plays a uniquely important role at the intersection of clinical knowledge, coding expertise, and operational leadership. This is not a corporate oversight role - it is a proactive, hands-on position embedded within Essen Health Care and Nursing Home operations to identify and resolve compliance issues at the source, before they reach external review. If you are a clinically trained professional who understands how care is delivered and how it must be accurately documented and billed, this is a role where your expertise will have immediate, measurable impact.
Equal Opportunity Employer
Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.

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