• HCC Risk Adjustment QA…

    Providence (Beaverton, OR)
    …best people, we must empower them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + ... Perform internal coding audits of Hhierarchical Condition category ( HCC ) coding review for Risk Adjustment staff, contractors, and vendors + Perform audits… more
    Providence (10/31/24)
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  • Risk Adjustment Auditor Educator

    Centene Corporation (Tallahassee, FL)
    …Organization as a medical coder **2+ years of experience** in coding with knowledge of Medicare risk adjustment ( HCC Coding) Required experience in ... record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care.… more
    Centene Corporation (09/25/24)
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  • HCC Risk Adjustment Coder

    MedKoder (Mandeville, LA)
    …production). Must have at least 1 year of specialized experience in Medicare Risk Adjustment disciplines- such as HCC , CCC HEDIS + Auditing experience ... a PLUS. ICD-10 experience/education a PLUS. About MedKoder, LLC: * Privately held, growing company with strong values and ethics * Professional development and education * All positions are permanent - no contracts or sitting on a "coding bench" * Generous… more
    MedKoder (10/16/24)
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  • RN Care Coordinator

    Covenant Health Inc. (Knoxville, TN)
    …in care coordination efforts. + Demonstrates knowledge of HEDIS, HCC 's and Medicare Risk Adjustment and their impact on pay-per-performance contracts. + ... Perform other duties as assigned or requested. Qualifications Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority. Minimum… more
    Covenant Health Inc. (10/23/24)
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  • HCC Coding Analyst Supervisor

    Intermountain Health (Columbus, OH)
    …role will have the responsibility of advising and mentoring caregivers on the Risk Adjustment coding team and ensuring efficient workflow and quality results. ... They provide expert-level proficiency in the areas of Risk Adjustment Coding for highly regulated government...Coding for highly regulated government insurance programs such as Medicare Advantage (MA), Medicaid, and the Affordable Care Act… more
    Intermountain Health (11/06/24)
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  • HCC Coding Compliance Assistant-KS Plan…

    Kelsey-Seybold Clinic (IA)
    …or CPC (Certified Professional Coder) or CPC-A or CRC (Certified Risk Adjustment Coder) Preferred: N/A **Special Skills** Required: Analytical. ... the accurate coding of diagnoses which fall into the HCC model as required by CMS for Medicare...Official ICD-10-CM Guidelines for Coding and Reporting. **Job Title: HCC Coding Compliance Assistant-KS Plan Advantage- Risk Adjustm**… more
    Kelsey-Seybold Clinic (11/05/24)
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  • Legal Compliance Advisor- Medicare Part C…

    The Cigna Group (Bluffton, SC)
    …audit. **Qualifications:** Bachelor's degree or equivalent. **5+ years of experience with Medicare Risk Adjustment -is required.** 5+ years of experience ... coding skills (including ICD-9 and ICD-10), strong knowledge of HCC 's and risk scores, communication and collaborative...Adjustment Data Validation Audits required. Strong knowledge of Medicare Risk Adjustment regulations required.… more
    The Cigna Group (09/24/24)
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  • Remote HCC Coder (CPC)

    Insight Global (Tampa, FL)
    Job Description Insight Global is hiring 3 HCC / Risk Adjustment Certified Professional Coders to support a backlog for inpatient and outpatient Medicare ... vs profee. Most of the markets are strictly risk adjustment focusing on HCC ...HCC codes. These markets are still only reviewing Medicare Advantage members. I would say 20-30% of our… more
    Insight Global (11/01/24)
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  • Ambulatory HCC Coding Educator & Regulatory…

    CaroMont Health (Gastonia, NC)
    …Clinical Documentation Specialists regarding coding guidelines and documentation required to capture HCC 's for Risk Adjustment coding. Train and educate ... HCC coding issues. Work with payer representatives who audit HCC coding for Managed Medicare plans and participate in the sharing of those audits with staff… more
    CaroMont Health (10/26/24)
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  • Medicare Advantage Risk

    UCLA Health (Los Angeles, CA)
    Description As the Medicare Advantage Risk Adjustment ...+ Three or more years of recent experience in CMS- HCC Risk Adjustment models V24 ... Trainer and Auditor, you will be an expert in risk adjustment coding and documentation, working closely...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required… more
    UCLA Health (08/29/24)
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  • Staff VP Compliance Medicare Operations…

    Elevance Health (Atlanta, GA)
    …Part D and risk adjustment . + Knowledge of Risk Adjustment Payment methodologies and the CMS HCC Model. + Healthcare operations and/or compliance ... **Preferred Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but not limited… more
    Elevance Health (11/06/24)
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  • Risk Adjustment Provider Educator…

    The Cigna Group (Houston, TX)
    …providers and internal matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise ... **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment &...process, anatomy, and physiology. + Working Knowledge of CMS Risk Adjustment and HCC Coding… more
    The Cigna Group (11/07/24)
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  • Risk Adjustment Coder II

    Point32Health (MA)
    …medical and business side of healthcare operations. + Ability to read and understand Medicare Advantage and ACA Risk Adjustment protocols. + Professional, ... here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Risk Adjustment Supervisor/Manager, performs accurate and timely review and… more
    Point32Health (10/09/24)
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  • Risk Adjustment Analyst

    VNS Health (Manhattan, NY)
    …areas, including Medicaid. + Maintains current knowledge of CMS' Hierarchical Condition Categories ( HCC ) and Prescription Drug Risk Adjustment codes (RxHCCs) ... OverviewSupports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk more
    VNS Health (10/03/24)
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  • HFHP Associate Risk Adjustment

    Health First (Rockledge, FL)
    *POSITION SUMMARY* This role contributes to Health First Health Plans' (HFHP) Risk Adjustment data collection, supporting compliance with regulatory and ... business. This individual will ensure the integrity of HFHP risk adjustment data by critically analyzing and...and submitting documented diagnosis codes to the Centers for Medicare & Medicaid Services (CMS). 2. Assist in process… more
    Health First (10/25/24)
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  • Actuarial Manager, Accountable Care

    CVS Health (Overland Park, KS)
    …working with large Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS- HCC ) analysis -Excellent oral & written communication ... **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment ...(MSSP and ACO REACH), including but not limited to risk adjustment opportunities, HCC gaps,… more
    CVS Health (11/02/24)
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  • Complex Coder Physician Practice General Medicine

    Banner Health (AZ)
    …Multi-Specialty - General Medicine (some HCC ) Coding** **experience** with Certified Risk Adjustment Coder (CRC) certification in an active status, and have ... with General Medicine: Multi-Specialty experience.** This is a skilled team that supports HCC , Hospitalist and Toxicology - and has an opportunity for growth in… more
    Banner Health (09/21/24)
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  • Coding Data Quality Auditor

    CVS Health (Tallahassee, FL)
    …Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories ( HCC ) preferred. + CRC ... ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
    CVS Health (10/26/24)
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  • Onsite Coding Auditor, SAMF Admin CBO - Full Time…

    Trinity Health (Fresno, CA)
    …to local ministry and Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder ... and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS). Monitor's accuracy of centralized coder's charge… more
    Trinity Health (10/02/24)
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