Risk Adjustment Coding Jobs in USA with Visa Sponsorship
Risk adjustment coding roles attract strong H-1B and green card sponsorship from health plans, managed care organizations, and risk-bearing provider groups. Employers routinely sponsor CRC-credentialed coders, with specialty occupation status supported by healthcare administration or health information management degrees. For detailed occupation requirements, see the O*NET profile.
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Identifies, collects, assesses, monitors and documents ICD-10 diagnoses based coding information as it pertains to CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding compliance and consistency. Supports the creation, maintenance, and enhancement of clinical documentation accuracy in support of building a model of care focused on quality and health outcomes. Works internally to leverage clinical, coding, and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation. Assists healthcare providers to understand specific documentation topics as well as the issues facing healthcare providers to create buy-in. Alerts leadership of trends and irregularities evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC alerts addressed at DOS. Works under moderate supervision.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Conducts coding reviews independently on all medical record documentation to assign and/or audit the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology. Outreaches supervisor for non-routine issues and new situations.
- Responsible for ensuring completion of medical record reviews and related accurate score based on monthly target set forth by department.
- Keeps current on new coding and billing guidelines and federal and state initiatives regarding claims and educates other departments on new/changes to regulations.
- Regulatory Oversight and Quality Assurance and performs medical record compliance audits using the most up-to-date CMS guidelines, output generated is submitted to CMS to accurately capture member’s acuity resulting in a compliance and financial impact to the organization, maintains high level of quality and production standards required by leadership to ensure continued medical coding accuracy. This requires advanced knowledge, certifications, and experience related to coding/auditing of ICD 10 Diagnoses based on HCC category.
- Provides audit trail for all identified HCCs in a Medical Record Review through use of audit tool.
- Identifies all unsupported diagnoses/HCCs for all Risk Adjustment Data Validation (RADV) related projects and appropriately notifies management of deficiencies to report to Encounter submissions team.
- Provider Engagement, Audit, Training and Support and supports supervisor in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
- Reports incidental findings, patterns, and trends from audits/coding projects to supervisor thus assisting supervisor in analyzing audit results, tracking and trending. Responsible for supporting supervisor/manager for testing of Coding/Audit tool to ensure appropriate functioning, identifying trends, making recommendations for process improvement for ensuring compliance.
- Enterprise Wide Risk Adjustment Collaboration Activities and Initiatives and support Manager in driving enterprise-wide risk adjustment initiatives. Collaborates internally with Special Investigations and Compliance supporting medical record review and claims analysis for determination of provider engagement in fraud, waste and abuse. Provides guidance to claims team, SIU, and other teams related to ICD 10 Diagnoses codes, CPT and HCPCS codes related to Risk Adjustment in addition to identifying updates for all measures and contract billing codes, as necessary.
- Assists in identifying, developing and implementing Medicaid Risk Adjustment initiatives and activities for ensuring member’s acuity aligns with Risk Scores with accurate coding of CHA Assessments.
- Monitors Risk Scores for member’s/population, monitoring the dashboards for Utilization and Risk Scores, identifies any deviation in patterns and working leaders and analyst on identifies the root cause and implements an action plan.
- Collaborates with other departments on CHA assessment completion and accuracy.
- Assists in Audit activities of CHA Assessments at a frequency determined as per the workplan.
- Educates and monitors completion of any accompanying action items related to audits, such as trending/tracking of audit scores for improvement, reporting any abnormal findings or patterns to the leadership for development of action items and follow up on action items.
- Identifies ongoing possible discrepancies through review of CHA Assessments and reporting, sharing with assessors and monitoring for corrections if needed on an ongoing basis.
- Collaborates with education department in the development and implementation of Risk Adjustment related training programs.
- Collaborates with Assessment units and other teams to ensure compliance with CMS and DOH standards.
- Keeps informed of the latest internal and external issues and trends in Risk Score activities through networking, professional memberships in related organizations, DOH resources/websites and email updates.
- Assists in development, revisions and updating workflows and policies and procedures related to Risk Adjustment activities.
- Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
- Active Certified Coder Certification through AHIMA or AAPC required
Education
- Associate's Degree or equivalent work experience required
Work Experience
- Minimum two years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems required
- Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits required
- Additional years of experience/specialized certification/training may be considered in lieu of educational requirements required
- Knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures required
- Strong knowledge of claims processing procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications required
- Strong planning, organizational, interpersonal, verbal and written communication skills required
- Knowledge of HIPAA, understanding a commitment to Privacy, Security and Confidentiality of all medical chart documentation required
- Ability to work both in a fast-paced environment and/or be independently self-driven to complete day to day tasks required
- Ability to switch gears and independently collaborate with other departments for all ad lib projects as necessary required
Pay Range
USD $33.88 - USD $42.35 /Hr.
About us
VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
Overview
Identifies, collects, assesses, monitors and documents ICD-10 diagnoses based coding information as it pertains to CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding compliance and consistency. Supports the creation, maintenance, and enhancement of clinical documentation accuracy in support of building a model of care focused on quality and health outcomes. Works internally to leverage clinical, coding, and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation. Assists healthcare providers to understand specific documentation topics as well as the issues facing healthcare providers to create buy-in. Alerts leadership of trends and irregularities evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC alerts addressed at DOS. Works under moderate supervision.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Conducts coding reviews independently on all medical record documentation to assign and/or audit the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology. Outreaches supervisor for non-routine issues and new situations.
- Responsible for ensuring completion of medical record reviews and related accurate score based on monthly target set forth by department.
- Keeps current on new coding and billing guidelines and federal and state initiatives regarding claims and educates other departments on new/changes to regulations.
- Regulatory Oversight and Quality Assurance and performs medical record compliance audits using the most up-to-date CMS guidelines, output generated is submitted to CMS to accurately capture member’s acuity resulting in a compliance and financial impact to the organization, maintains high level of quality and production standards required by leadership to ensure continued medical coding accuracy. This requires advanced knowledge, certifications, and experience related to coding/auditing of ICD 10 Diagnoses based on HCC category.
- Provides audit trail for all identified HCCs in a Medical Record Review through use of audit tool.
- Identifies all unsupported diagnoses/HCCs for all Risk Adjustment Data Validation (RADV) related projects and appropriately notifies management of deficiencies to report to Encounter submissions team.
- Provider Engagement, Audit, Training and Support and supports supervisor in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
- Reports incidental findings, patterns, and trends from audits/coding projects to supervisor thus assisting supervisor in analyzing audit results, tracking and trending. Responsible for supporting supervisor/manager for testing of Coding/Audit tool to ensure appropriate functioning, identifying trends, making recommendations for process improvement for ensuring compliance.
- Enterprise Wide Risk Adjustment Collaboration Activities and Initiatives and support Manager in driving enterprise-wide risk adjustment initiatives. Collaborates internally with Special Investigations and Compliance supporting medical record review and claims analysis for determination of provider engagement in fraud, waste and abuse. Provides guidance to claims team, SIU, and other teams related to ICD 10 Diagnoses codes, CPT and HCPCS codes related to Risk Adjustment in addition to identifying updates for all measures and contract billing codes, as necessary.
- Assists in identifying, developing and implementing Medicaid Risk Adjustment initiatives and activities for ensuring member’s acuity aligns with Risk Scores with accurate coding of CHA Assessments.
- Monitors Risk Scores for member’s/population, monitoring the dashboards for Utilization and Risk Scores, identifies any deviation in patterns and working leaders and analyst on identifies the root cause and implements an action plan.
- Collaborates with other departments on CHA assessment completion and accuracy.
- Assists in Audit activities of CHA Assessments at a frequency determined as per the workplan.
- Educates and monitors completion of any accompanying action items related to audits, such as trending/tracking of audit scores for improvement, reporting any abnormal findings or patterns to the leadership for development of action items and follow up on action items.
- Identifies ongoing possible discrepancies through review of CHA Assessments and reporting, sharing with assessors and monitoring for corrections if needed on an ongoing basis.
- Collaborates with education department in the development and implementation of Risk Adjustment related training programs.
- Collaborates with Assessment units and other teams to ensure compliance with CMS and DOH standards.
- Keeps informed of the latest internal and external issues and trends in Risk Score activities through networking, professional memberships in related organizations, DOH resources/websites and email updates.
- Assists in development, revisions and updating workflows and policies and procedures related to Risk Adjustment activities.
- Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
- Active Certified Coder Certification through AHIMA or AAPC required
Education
- Associate's Degree or equivalent work experience required
Work Experience
- Minimum two years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems required
- Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits required
- Additional years of experience/specialized certification/training may be considered in lieu of educational requirements required
- Knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures required
- Strong knowledge of claims processing procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications required
- Strong planning, organizational, interpersonal, verbal and written communication skills required
- Knowledge of HIPAA, understanding a commitment to Privacy, Security and Confidentiality of all medical chart documentation required
- Ability to work both in a fast-paced environment and/or be independently self-driven to complete day to day tasks required
- Ability to switch gears and independently collaborate with other departments for all ad lib projects as necessary required
Pay Range
USD $33.88 - USD $42.35 /Hr.
About us
VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
How to Get Visa Sponsorship in Risk Adjustment Coding
Target managed care and health plan employers
Large health plans and Medicare Advantage organizations file the most LCAs for risk adjustment coding roles. These employers have established immigration programs and legal infrastructure, making sponsorship significantly more straightforward than smaller outpatient clinics or independent practices.
Earn your CRC or CCS credential before applying
The Certified Risk Adjustment Coder credential from AAPC signals specialty-level expertise to both employers and USCIS. Credentialed candidates face far less resistance on specialty occupation determinations because the credential reinforces that the role requires specialized knowledge beyond general coding.
Frame your degree against the specialty occupation standard
USCIS scrutinizes whether risk adjustment coding genuinely requires a bachelor's degree. Degrees in health information management, healthcare administration, or biology strengthen your petition considerably. Pair your degree with CRC certification to build the most defensible specialty occupation argument.
Ask about cap-exempt or cap-subject H-1B filing early
If your prospective employer is a nonprofit hospital system or university-affiliated health plan, you may qualify for cap-exempt H-1B filing year-round. Confirm the employer's cap status before the April lottery window closes so you're not waiting an additional year.
Negotiate an employment start date that accounts for processing
Standard H-1B processing runs three to five months. If you're changing employers or entering from outside the U.S., build that buffer into your offer negotiation. Premium processing reduces the adjudication window to roughly two weeks and is worth requesting for time-sensitive starts.
Document remote work arrangements explicitly in your petition
Risk adjustment coding is commonly performed remotely, but USCIS requires Labor Condition Applications to list all worksite locations. If you'll work from home, your employer must file an LCA covering your home address state to keep your petition in compliance.
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Get Access To All JobsFrequently Asked Questions
Is risk adjustment coding considered a specialty occupation for H-1B purposes?
It can qualify, but USCIS evaluates these petitions closely. The strongest cases pair a bachelor's degree in health information management, healthcare administration, or a clinical field with a CRC or CCS credential and a job description emphasizing complex ICD-10-CM hierarchical condition category analysis. Generic coding roles with broad degree requirements have faced RFEs, so specificity in the job description matters considerably.
Which employers are most likely to sponsor risk adjustment coders?
Medicare Advantage health plans, Medicaid managed care organizations, and large risk-bearing provider groups file the most LCAs for these roles. Companies running retrospective and prospective chart review programs at scale, including those serving CMS-contracted plans, tend to have active immigration programs. Browse open sponsorship roles on Migrate Mate to see which employers are currently hiring internationally.
Does a CRC certification substitute for a bachelor's degree in an H-1B petition?
No. USCIS requires a U.S. bachelor's degree or its equivalent in a specific specialty for H-1B classification. The CRC credential strengthens the specialty occupation argument but does not replace the degree requirement. If your degree is from outside the U.S., a credential evaluation from a NACES-member organization confirming equivalency to a U.S. bachelor's is required.
Can risk adjustment coders work remotely on an H-1B visa?
Yes, but the H-1B petition must reflect every location where work is performed. Your employer needs to file a Labor Condition Application listing your home address worksite, and you must have a copy of the LCA available at that location. Moving to a new state without updating the LCA and potentially amending the H-1B petition creates compliance risk for both you and your employer.
How long does green card sponsorship typically take for risk adjustment coding roles?
Most risk adjustment coders qualify under EB-3, which requires PERM labor certification before the I-140 immigrant visa petition. PERM itself takes roughly 18 to 24 months under current DOL processing times. For applicants born in India or China, priority date backlogs can extend total wait times considerably beyond that. EB-2 NIW is generally not applicable unless the role involves significant research or policy contributions.
What is the prevailing wage requirement for sponsored Risk Adjustment Coding jobs?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.
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