- 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
- Conviva (Columbus, OH)
- …providers + Medical record review knowledge + Medicare Risk Adjustment knowledge + Extensive knowledge of coding guidelines (ie ICD-10) + Comprehensive ... embedded within the clinical education team and will work also closely with Coding operations team and Clinical Excellence team under the CenterWell Primary Care… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …skills. + Building relationships + Working knowledge of clinical documentation requirements & Medicare Risk Adjustment coding Preferred: SCOPE ... nursing home reports, logs, medical records, etc + Complete timely health risk assessments + Complete routine monthly comprehensive assessments + Ensures appropriate… more
- 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
- 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
- Evolent Health (Columbus, OH)
- … HCC Coding Support Specialist** at Evolent will be an intricate part of the Risk Adjustment coding team. Coding for MSSP, MA and Commercial patients ... and coding conventions as well as CMS Risk Adjustment Data Validation (RADV) documentation guidelines...with experience in MSSP ACO programs, Value Based Care, Medicare Advantage and/or commercial risk adjustment… more
- 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
- Fallon Health (Worcester, MA)
- …and report on FCHP patient charts for the purpose of validating regulatory Risk Adjustment scores. The Chart Review Specialist will collect diagnostic details ... documentation feedback and submit to Manager for provider education efforts + Update risk adjustment software with all relevant chart review observations + Meet… more
- 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 hierarchical condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors + Perform audits… more
- Health First (Rockledge, FL)
- … Risk Adjustment Associates in order to increase awareness of the significance of Medicare Risk Adjustment (MRA) within the CMS Risk Adjustment ... departmental goals and deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human...model and IFP within the HHS Risk Adjustment model as well as the coding … more
- Tufts Medicine (Burlington, MA)
- …Provides education and feedback to physicians on a regular basis in regards to Risk Adjustment Coding guidelines (HCC/DxCG), as well as ICD-10-CM Guidelines ... position performs accurate and timely reviews and validations of Medicare , Medicaid, Commercial HCCs and DxCG's through medical record...coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive… more
- Martin's Point Health Care (Portland, ME)
- …Ideal candidates are those who are coming from a Health Plan and with strong Risk Adjustment and Medicare backgrounds. Job Description 100Key Outcomes: + ... Work" since 2015. Position Summary The Vice President of Risk Adjustment works closely and collaboratively with...Develops and maintains an expert level of knowledge of Medicare and risk -based reimbursement methodologies. + Operational… more
- CenterWell (Carson City, NV)
- …(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
- 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
- Banner Health (Phoenix, AZ)
- …and develops clinical strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of our MA, MSSP, Medicaid, ... as the clinical DYAD to the Executive Director of Risk Adjustment , co-leading a robust team that...illness burden. 3. Establish clinical education standards for our coding and PCR staff and ensure our internal and… more
- 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
- Centene Corporation (Olympia, WA)
- … adjustment experience highly preferred. Previous managed care or Medicare experience preferred. Previous healthcare claims coding experience is highly ... on workplace flexibility. **Position Purpose:** Manage the business processes related to risk adjustment and quality improvement across Centene's for assigned… more
- Highmark Health (Columbus, OH)
- …terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) ... to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare ...leadership to identify and deliver high quality and accurate risk adjustment coding . Supports all… more
- Conviva (Tallahassee, FL)
- …clinical documentation. + Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, ... provider coding improvement opportunities, risk score trending and tracking. + Partners with MRA...Ability to Travel **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions.… more
- CareOregon (Portland, OR)
- …years' healthcare, claims, data management, EDI experience Preferred + Experience with Medicare Advantage risk adjustment and payment methodologies ... statistical software packages, such as SAS + Knowledge of risk adjustment methodology and Medicare ...and/or pharmacy claims + Knowledge of CPT, HCPCS, ICD10 coding ; revenue codes; DRG, UB04, and CMS 1500 claims… more