• Risk Adjustment Auditor Educator

    Centene Corporation (Tallahassee, FL)
    …as a medical coder **2+ years of experience** in coding with knowledge of Medicare risk adjustment (HCC Coding ) Required experience in teaching, ... interventions at the provider and market level. + Subject matter experts for proper risk adjustment coding and CMS data validation + Work in conjunction with… more
    Centene Corporation (09/25/24)
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  • HFHP Risk Adjustment Operations…

    Health First (Rockledge, FL)
    …coordinates and evaluates the activities of personnel engaged in Medicare Risk Adjustment audits, clinical coding and related projects production. ... * Develop and manage quality assurance programs for internal coding projects for Risk Adjustment ...with Government Program Director to develop a comprehensive, long-term Medicare risk adjustment strategy. *Stewardship:… more
    Health First (11/07/24)
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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 ... for the Cigna Compliance Department, with particular emphasis on Coding , Risk Adjustment and ...Adjustment Data Validation Audits required. Strong knowledge of Medicare Risk Adjustment regulations required.… more
    The Cigna Group (09/24/24)
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  • Senior Director, Medicare Risk

    Somatus (Mclean, VA)
    …and mental well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and ... Finance and Analytics team to establish risk adjustment analytics such as predictive modeling for coding...experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions.… more
    Somatus (10/09/24)
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  • Medicare Advantage Risk

    UCLA Health (Los Angeles, CA)
    Description As the Medicare Advantage Risk Adjustment ...Trainer and Auditor, you will be an expert in risk adjustment coding and documentation, ... working closely with physicians, IPA coders, and risk adjustment teams associated with the health...understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems required + Knowledge of Medicare more
    UCLA Health (08/29/24)
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  • HCC Risk Adjustment QA Auditor:…

    Providence (Beaverton, OR)
    …the best people, we must empower them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + ... 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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  • Senior STARS Improvement Consultant

    Humana (Montgomery, AL)
    …and influencing execution of recommended strategy + Experience with Medicare Risk Adjustment and/or medical coding + Understanding of Consumer/Patient ... Senior Stars Improvement Consultant / Professional executes the overall Medicare Stars Improvement Program within the market, including development, implementation… more
    Humana (10/31/24)
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  • Risk Adjustment Provider Educator…

    The Cigna Group (Houston, TX)
    …Registered Health Information Management Technician (RHIT) + 5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan ... internal matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise in… more
    The Cigna Group (11/07/24)
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  • Risk Adjustment Coder II

    Point32Health (MA)
    Medicare Advantage, Commercial and Medicaid HCCs through medical record reviews. The Risk Adjustment Coding Specialist II reviews provider documentation ... improve overall provider documentation and coding . The Risk Adjustment Coding Specialist II...of healthcare operations. + Ability to read and understand Medicare Advantage and ACA Risk Adjustment more
    Point32Health (10/09/24)
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  • HFHP Associate Risk Adjustment

    Health First (Rockledge, FL)
    …medical records with documentation to include coding of ICD-10-CM codes to validate Risk Adjustment data for the MA and/or IFP lines of business. 4. Maintain ... and submitting documented diagnosis codes to the Centers for Medicare & Medicaid Services (CMS). 2. Assist in process...coding education updates. 7. Remain current on diagnosis coding guidelines and risk adjustment more
    Health First (10/25/24)
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  • Associate Director, Risk Adjustment

    CenterWell (Tallahassee, FL)
    …(CMS), other payers, and over government agencies. In addition, the Associate Director, Risk Adjustment oversees all medical coding education activities. The ... understanding of how organization capabilities interrelate across departments. The Associate Director, Risk Adjustment ensures coding is accurate and… more
    CenterWell (10/30/24)
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  • Risk Adjustment Program Manager

    CVS Health (New Albany, OH)
    …has an exciting opportunity for a Program Manager to join our Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP lines of business! In ... a hybrid project manager and subject matter expert in Risk Adjustment chart retrieval & coding...production management, and reporting for the Risk Adjustment Retrospective Program for ACA, Medicare , MMP… more
    CVS Health (11/02/24)
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  • HCC Risk Adjustment Coder

    MedKoder (Mandeville, LA)
    …(recent hands-on production). Must have at least 1 year of specialized experience in Medicare Risk Adjustment disciplines- such as HCC, CCC HEDIS + ... Position Location: 100% Remote Qualifications The Medical Coder provides coding and coding auditing services directly to providers. This includes the analysis… more
    MedKoder (10/16/24)
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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. ... ICD-10-CM Guidelines for Coding and Reporting. **Job Title: HCC Coding Compliance Assistant-KS Plan Advantage- Risk Adjustm** **Location: 100% Remote**… more
    Kelsey-Seybold Clinic (11/05/24)
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  • HCC Coding Analyst Supervisor

    Intermountain Health (Columbus, OH)
    …This 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... 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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  • Coding Data Quality Auditor

    CVS Health (Tallahassee, FL)
    …Qualifications** + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred. ... 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…

    Trinity Health (Fresno, CA)
    …Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder education. Conducts ongoing ... and procedures; and ensuring proper assignment of diagnosis and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid… more
    Trinity Health (10/02/24)
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  • Regional Manager, Professional Coding THMG

    Trinity Health (Livonia, MI)
    …Coder (CPC) or RHIT Preferred: Certified E&M Coder (CEMC), and/or Certified Risk Adjustment Coder (CRC). Maintains annual CEU requirement. Required: Minimum ... knowledge of CPT, ICD-10-CM (ICD-9-CM) and HCPCS level II coding guidelines, along with CCI edits and Medicare... coding guidelines, along with CCI edits and Medicare claims processing manual contents in a multi-facility, integrated… more
    Trinity Health (11/02/24)
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  • Coding Quality Auditor, Clinical…

    Hackensack Meridian Health (Neptune, NJ)
    …but not limited to Microsoft Office and Google Suite platforms. + Knowledge of Risk Adjustment by using Vizient Calculator to increase expected mortality and ... transform healthcare and serve as a leader of positive change. The Coding Quality Auditor is responsible for monitoring compliance with applicable clinical… more
    Hackensack Meridian Health (11/02/24)
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  • Ambulatory HCC Coding Educator & Regulatory…

    CaroMont Health (Gastonia, NC)
    …Specialists regarding coding guidelines and documentation required to capture HCC's for Risk Adjustment coding . Train and educate coding staff ... 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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