Certified Risk Adjustment Coder
Mount Sinai Medical Center of Florida
## Certified Risk Adjustment CoderApplylocations: Hialeah, FLtime type: Full timeposted on: Posted Todayjob requisition id: JR102682**As Mount Sinai grows, so does our legacy in high-quality health care.**Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.**Culture of Caring: The Sinai Way**Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.**Department:****Job Description Summary:**## Position Responsibilities* Demonstrates knowledge of coding and documentation standards as well as CMS risk adjustment guidelines and HCCs (hierarchical condition categories)* Reviews medical record to ensure all diagnosis codes are documented for the assignment of a valid and accurate HCC for each episode of care* Regularly reviews Epic HCC and payor CSI (Clinically Suspect Conditions) reports* Queries and provides feedback and education to physicians when identifying documentation deficiencies to improve accuracy of risk adjustment coding* Demonstrates understanding of risk adjustment payment models* Uses clinical reasoning and critical thinking skills to discern the financial impact of a query in order to prioritize efforts most efficiently* Completes patient medical chart review within 24-48 hours of visit completion* Responsible for maintaining active status of coding credentials and completes annual continued education hours.* Observes work hours and provides proper notice regarding absences and tardiness* Maintains positive working relationship with Physician Practices, Managed Care and all other departments and communicates with office staff as needed.* Performs other related duties.## Qualifications* ### License/Registration/Certification + CPC, CCS-P or CRC Certification Required* ### Education + High School graduate* ### Experience + Five plus years experience in Coding and Billing, Knowledge of ICD-10-CM and CPT**Benefits:**We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:* Health benefits* Life insurance* Long-term disability coverage* Healthcare spending accounts* Retirement plan* Paid time off* Pet Insurance* Tuition reimbursement* Employee assistance program* Wellness program* On-site housing for select positions and more!**Degree Requirements:****Certification:**### About UsMore than 4,000 people work at Mount Sinai Medical Center at more than a dozen locations throughout sunny South Florida, including our flagship, 672-bed hospital on Biscayne Bay at the gateway to Miami Beach. We’re the largest, independent, not-for-profit hospital in South Florida, and we’re the only hospital Healthgrades recognized for four years running as one of the top 5% in the nation. Clearly, clinical excellence is at our core. #J-18808-Ljbffr
- ...Baptist Health is seeking a Certified Professional Coder to perform medical record reviews and coding to support risk adjustment and Medicare compliance. The role involves identifying documentation gaps, communicating with providers, and ensuring accurate ICD-10-CM coding...Risk
- Mount Sinai Medical Center of Florida, Inc. is seeking a Certified Risk Adjustment Coder to ensure accurate coding and documentation standards. The role involves reviewing medical records, providing feedback to physicians, and maintaining coding credentials. The ideal candidate...Risk
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- Cano Health is looking for a Risk Adjustment Coder in the Town of Florida, NY. The role involves identifying and documenting claims coding information while ensuring the accuracy of diagnosis codes. Candidates should have two years of medical coding experience and relevant...RiskWork at office
- ## Risk Adjustment CoderApplyremote type: Hybridlocations: Jupiter, FLtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR4... ...healthcare enthusiasts to join us.**Job Summary**The Risk Adjustment coder will identify, collect, assess, monitor and document claims...RiskWork at officeFlexible hoursWeekend work
- ...independently with minimal oversight from leadership or higher‑level coders. Conduct retrospective audits of medical records to validate... ...outliers and improvement opportunities. Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and...Risk
$20.5 - $27.85 per hour
...Required. Certifications/Registration Requirements : CPC (Certified Professional Coder) Preferred or COC (Certified Outpatient Coding)... ...Preferred Additional Requirements CRC (Certified Risk Adjustment Coder) required -or- CIC (Certified Inpatient Coder) required...RiskCasual workRemote work- Millennium Physician Group is seeking a RISK ADJUSTMENT CODING SPECIALIST to abstract and assign ICD‑10‑CM diagnosis codes and conduct audits of medical records. The role requires advanced knowledge of medical terminology and coding practices, with a strong emphasis on...Risk
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- ...serves as the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. Responsibilities include analyzing trends, triaging inquiries, researching coding guidelines,...Risk
- ...ACCOUNTABILITY ACCURACY (DRG) ACCURACY - CODER ACCURACY - OUTPATIENT ANALYSIS AND... ...Diploma or Equivalent (Required) Certified Coding Associate (CCA) - American Health... ...Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC) by AAPC, or Certified...RiskWork experience placementWork at officeLocal areaShift work
- Mount Sinai Medical Center is seeking a qualified candidate with extensive coding experience to ensure accurate documentation and compliance. The role requires a minimum of five years' experience in coding and billing, along with a CPC, CCS-P, or CRC certification. This...Risk
- Blue Cross Blue Shield of Nebraska seeks a Healthcare Analytics professional to support the Risk Adjustment Programs by analyzing healthcare data to evaluate program performance, measure financial and clinical impact, and identify opportunities for improvement. The role...RiskRemote job
- Nebraska Blue Cross and Blue Shield is seeking a Risk Adjustment Health Data Analyst to join our Healthcare Analytics team. You will analyze claims, enrollment, and risk adjustment submissions to evaluate program performance and identify opportunities for improvement. The...RiskRemote job
- ...maintain HCC performance reporting Support predictive modeling initiatives Monitor vendor performance Design, develop, and maintain risk adjustment performance dashboards and reports using Power BI, Tableau, or equivalent tools to monitor KPIs Write and optimize complex SQL...Risk
- ...company expertise. Our Crop Division has been helping farmers manage risk since 1915 and is one of the few private companies authorized by... ...part‑time. Hours fluctuate based on seasonal needs. As a Crop Adjuster, You Will Understand and work claims for all major crops,...RiskFull timePart timeSeasonal work
- ...The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation... ...systems Escalate complex or high-risk cases to the Medical Director as... ...Active credential in one of the following: Certified Coding Specialist (CCS) Minimum of five...RiskFull timeWork at officeRemote workWork from homeHome office
$75k - $92k
...insurance needs of the wheels‑based transportation industry. We offer risk financing solutions across all 50 states, including traditional... ...and alternative risk transfer programs. Position Workers Comp Adjuster - fully remote (USA) Essential Job Functions And...RiskRemote jobFull timePart timeSeasonal work$67.9k - $199.14k
...community at a time. Position Summary CVS Health has an exciting opportunity for a Senior Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will lead and execute complex data analyses to drive health plan‑level risk adjustment...RiskRemote jobHourly payFull timeTemporary workWork experience placementLocal area$55 - $65 per hour
...and logistics services; commercial and personal insurance and risk management; and retail automotive sales as one of the largest privately... ...storm and has a perfect opportunity for a highly desired Gold Certified Technician to join the Holman family. Up to $10,000 sign-on...RiskHourly payLocal areaRelocation packageFlexible hours- ...providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. Responsibilities include... ...with workflows and ensuring tool use. Participate in a daily coder helpdesk (virtual/Zoom‑based) to provide real‑time support and...RiskTemporary workImmediate startMonday to Friday
$70k - $90k
...global clients to solve their most complex risk management challenges, delivering... ...employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners... .... This is a full life‑cycle WC adjuster position within a TPA environment, and only...RiskWork at officeRemote work- ...centric approach, we are committed to transforming healthcare and creating a better care experience for all. SCOPE OF ROLE The Risk Adjustment and Analytics Team is working to push boundaries to redefine Risk Adjustment and Quality Analytics in a Value-Based Care...Risk
$23.21 - $29.48 per hour
...ICD-10-CM coding and billing and compliance with Medicare Risk Adjustment metrics. Supports continuum of patient care by... ...Trade (Trn) Experience Licenses & Certifications: AAPC Certified Professional Coder. AAPC Certified Risk Adjustment Coder. Additional Qualifications...RiskRemote job- The Healthcare Analytics role supports the Risk Adjustment Programs team by analyzing healthcare data to evaluate program performance, measure financial and clinical impact, and identify opportunities for improvement. This role develops reporting, forecasts, and actionable...RiskLive inRemote work
- Jobtailor seeks a senior analytics leader to oversee complex risk adjustment, revenue and financial analyses for Medicaid. You will own end-to-end Medicaid risk adjustment processes across markets, driving holistic and consistent solutions across the organization. You will...Risk
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- ...Memorial Healthcare System is seeking a Certified Nurse Midwife (Per Diem) to join the High-Risk OB/GYN team at Memorial Regional Hospital, one of South Florida's leading maternity care programs. This is an outstanding opportunity to become part of a collaborative, multidisciplinary...RiskDaily paidFlexible hoursNight shiftDay shiftAfternoon shift
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