- The Cigna Group (Bloomfield, CT)
- …with HCC coding (required). + Extensive knowledge of CMS guidance of Risk Adjustment & ICD-10 CM diagnosis guidelines (required). + Extensive knowledge of ... quality, as set by internal standards, to ensure continued auditor accuracy. + Stays up-to-date with current Cigna Medicare... accuracy. + Stays up-to-date with current Cigna Medicare coding guidelines. + Maintains coding credentials &… more
- UCLA Health (Los Angeles, CA)
- … Provider Documentation Trainer and Auditor , you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA ... Risk Adjustment...coders, and risk adjustment teams associated with the health...physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic… more
- Providence (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
- Centene Corporation (Tallahassee, FL)
- …of interventions at the provider and market level. + Subject matter experts for proper risk adjustment coding and CMS data validation + Work in conjunction ... practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment...experience** in coding with knowledge of Medicare risk adjustment (HCC Coding ) Required… more
- Catholic Health Initiatives (Chattanooga, TN)
- …team to support the needs of the organization. The position will support risk adjustment improvement efforts across the medical group. The Hierarchical Condition ... hospital, connect with us today! **Responsibilities** **Job Summary / Purpose** The Sr Coding Compliance Auditor is responsible for reviewing chart notes for… more
- 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 ... healthcare and serve as a leader of positive change. The Coding Quality Auditor is responsible for monitoring compliance with applicable clinical documentation… more
- 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 ... procedures; and ensuring proper assignment of diagnosis and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services… more
- Point32Health (MA)
- …of 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...HHS-RADV Audits to include preparing chart for Initial Validation Auditor (IVA). Evaluates results from IVA and when applicable,… more
- UPMC (Pittsburgh, PA)
- …+ Experience with DRG Assignment and clinical validation of diagnoses. + Experience with HCC/ Risk Adjustment coding preferred. + Proficiency using Epic, One ... UPMC Health Plan is looking for an Intermediate Clinical Auditor /Analyst to join the Quality Assurance team! This role will work standard daylight hours, Monday -… more
- Hackensack Meridian Health (Hackensack, NJ)
- …+ Reviews CDI quality liaison recommendations as it relates to mortality, PSI/HAC, POA and risk adjustment codes and makes changes as needed in compliance with ... with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency and efficiency in filing… more
- 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 ... of the Trinity Health Medial Group's (THMG) Regional Professional Certified Coding Site Operations team. The manager partners with auditing, billing, finance,… more
- AIG (Houston, TX)
- …a Team Manager, Underwriting Support. This role assists the underwriters by screening risk offerings and with pre and post-binding processes. The role also performs ... Review new submissions against prescribed criteria to determine if risk qualifies for LOB risk appetite. Triages...coverages and program structures, as well as internal policy coding systems to ensure account completeness. + Designated as… more
- SSM Health (MO)
- …scoring. + Collaborates with others regardingclinical documentation improvement (CDI) and risk adjustment (mortality) findings. + Maintains knowledge of Centers ... Performs as a vital member of the interdisciplinary care team member, an auditor , and an educator ensuring medical records are complete and clinical documentation… more
- CVS Health (Tallahassee, FL)
- …with your market + Knowledge of HEDIS and Pay for Performance metrics, ICD-10 coding , Medicaid risk adjustment methodology, and common billing and common ... sharing provider performance metrics related to quality, clinical outcomes, coding , and utilization used to support ABH programs. They...+ RHI, RHIT, CRC, or CPC certified Coder or auditor (CMAS) or + RN or LPN or LISW… more