- ChenMed (Miami, FL)
- …departments to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A ... to collect and review documents to support the organization's quality and risk adjustment initiatives,...is unsubstantiated by the record should be queried to provider and assess to accuracy. + Reviews for clinical… more
- Molina Healthcare (MS)
- …role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider ... providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals. * Drives provider partner coaching and… more
- MedKoder (Mandeville, LA)
- …+ Assign accurate ICD-10 codes based on documentation, ensuring compliance with CMS risk adjustment and quality guidelines. + Utilizing proprietary ... Description: MedKoder, LLC is seeking a remote Professional HCC Risk Adjustment Coder who will apply both...coding practices. + Attend conference calls as necessary to provide information and/or feedback. + ️Maintain confidentiality and ensure… more
- Centene Corporation (Springfield, IL)
- …federal, and NCQA requirements. + Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and ... to improve provider performance in areas of Quality , Risk Adjustment and Operations...encounters). + Identifies specific practice needs where Centene can provide support. + Develops, enhances and maintains provider… more
- Centene Corporation (Tallahassee, FL)
- …federal, and NCQA requirements. + Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and ... to improve provider performance in areas of Quality , Risk Adjustment and Operations...encounters). + Identifies specific practice needs where Centene can provide support. + Develops, enhances and maintains provider… more
- Healthfirst (NY)
- …analysis + Minimum ten (10) years' experience in a combination of quality , provider engagement and/ risk adjustment , with at least 3 years in a ... leadership role in the delivery and execution of the risk adjustment program by driving value through...to ensure alignment across processes and work effort. + Provide guidance and thought leadership to analysts and staff… more
- Fairview Health Services (St. Paul, MN)
- …both formally and informally, regarding the impact of documentation on patient care, quality metrics, risk adjustment , and correct reimbursement. Adheres to ... support of building a model of care focused on quality and health outcomes. You will work closely with...clinical conditions and procedures to reflect severity of illness, risk adjustment , accurate coding, accuracy of patient… more
- Centene Corporation (Jefferson City, MO)
- …with Provider Relations to improve provider performance in areas of Quality , Risk Adjustment and Operations (claims and encounters). + Assists in ... communication such as newsletter articles, member education, outreach interventions and provider education. + Supports quality improvement HEDIS and program… more
- Dignity Health (Bakersfield, CA)
- …DHMSO and its clinical integrated networks throughout to identify opportunities for improved quality , risk adjustment coding performance. The Value Based ... owned by Dignity Health. As a member of the Quality Management/ Risk team, the Value Based Coder...and review network coding opportunities as it pertains to risk adjustment . - Ensure that the diagnosis… more
- Medical Mutual of Ohio (OH)
- …for adherence to Company polices for the most precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA. . ... for the most precise medical codes. Audits vendors for quality assurance of risk adjustment ...trusted by businesses and nonprofit organizations throughout Ohio to provide high- quality health, life, disability, dental, vision… more
- VNS Health (Manhattan, NY)
- …charts, to identify areas of opportunity to support accuracy clinical documentation. Works with Risk Adjustment and Quality team to identify topics, areas ... coders at their practice locations. + Travels between numerous provider offices across all regions to promote Quality...and + Certified Coding Specialist (CCS) or (CRC) Certified Risk Adjustment Coder or Registered Health Information… more
- Molina Healthcare (West Valley City, UT)
- …but not limited to: Risk / Quality rate trending and forecasting; provider Risk / Quality measure performance, CAHPS and survey analytics, health equity ... & ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of experience supporting HEDIS engine… more
- CVS Health (Overland Park, KS)
- …(Medicare Advantage, MSSP, ACO REACH).** **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk ... (MSSP and ACO REACH), including but not limited to risk adjustment opportunities, HCC gaps, and benchmarking...claims data, including 100% Medicare data or VRDC, to provide actionable insights to stakeholders + Get up to… more
- Medical Mutual of Ohio (Toledo, OH)
- …for adherence to Company policies for the most precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA. ... **Job Summary:** Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA (Medicare Advantage) with… more
- Banner Health (AZ)
- …findings and develop an improvement plan to meet organizational goals. Partners with Risk Adjustment Quality Analysts and Educators to develop educational ... as an informative source on Medicare Advantage funding models ( Risk adjustment , HCCs, HEDIS quality ...program's financial benefit to Banner Health. 4. Partners with Risk Adjustment resources to provide … more
- Mount Sinai Health System (New York, NY)
- …CDQI, who will (1) be responsible for driving key population health goals including access, quality , utilization and accurate risk adjustment with a group of ... and research/education. We have ~40,000 employees working together to provide billions of dollars in high- quality care...hardwiring processes to drive excellence in efficiency of care, quality and accurate risk adjustment … more
- Medical Mutual of Ohio (OH)
- …departments on risk adjustment coding strategies, HEDIS performance, provider performance, and other corporate quality initiatives. Develops and executes ... review of provider agreements.** + **Acts as project manager over large internal risk adjustment projects (eg, Optum In Office Assessment program for both MA… more
- reveleer (CA)
- About Reveleer Reveleer is a fast-growing technology-enabled services company that powers performance/ quality measurement and risk adjustment solutions in ... Care Organizations nationwide, leveraging software and other technology tools to accelerate their Risk Adjustment and Quality programs. Our mission is to… more
- Centene Corporation (New York, NY)
- …with Provider Relations to improve provider performance in areas of Quality , Risk Adjustment , Operations (claims and encounters). + Schedules doctor ... barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at… more
- Sanford Health (Sioux Falls, SD)
- …clinical operations team which includes utilization management, care management, population health, quality , risk adjustment and appeals and grievances. ... oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members. Reporting to the President and… more