• Risk Adjustment Clinical

    UPMC (Pittsburgh, PA)
    UPMC Health Plan has an exciting opportunity for a Risk Adjustment Clinical Auditor /Analyst position in the Medicare department. This is a full time ... hours and will be fully remote.. The Clinical Auditor /Analyst is an integral part of the Risk Adjustment Department and is responsible for reviewing and… more
    UPMC (09/30/25)
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  • Auditor , HCC Risk Adjustment

    Datavant (Denver, CO)
    …educational and life experiences to realize our bold vision for healthcare. As an Auditor , HCC Risk Adjustment Coder, you will review medical records ... using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical… more
    Datavant (08/08/25)
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  • Sr Coding Compliance Auditor

    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 ... **Job Summary and Responsibilities** **Job Summary / Purpose** The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an… more
    Catholic Health Initiatives (10/04/25)
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  • Analyst, Coding Data Quality Auditor

    CVS Health (IN)
    …to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical ... to such evidence across stakeholders with varying knowledge and clinical expertise in either written or verbal forms including...all body systems + Understand the audit process for risk adjustment models. + Identify and communicate… more
    CVS Health (10/02/25)
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  • Medical Coding Auditor

    CenterWell (Denver, CO)
    …+ 2 or more years of outpatient coding experience (Preferably in a risk adjustment setting) + Knowledge of various reimbursement methodologies, including ... and help us put health first** The Medical Coding Auditor extracts clinical information from a variety...risk adjustment and fee for service +...risk adjustment and fee for service + Must maintain annual… more
    CenterWell (10/01/25)
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  • Senior Auditor , Global Internal Audit…

    Bristol Myers Squibb (Princeton, NJ)
    …in their personal lives. Read more: careers.bms.com/working-with-us . Position Summary The Senior Auditor in GIA will work in a team environment to plan and execute ... dynamic risk -based audits and identify value-added recommendations to strengthen Company...key third-party outsourcing arrangements. Throughout the audits, the Senior Auditor will have the opportunity to interact with senior… more
    Bristol Myers Squibb (08/16/25)
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  • Coding Auditor & Educator

    WelbeHealth (Charleston, WV)
    …education and experience in coding and auditing + Minimum of two (2) years of Risk Adjustment (HCC) coding experience in a managed care environment + Current ... At the direction of the Coding Supervisor, the Coding Auditor and Educator focuses on ensuring coding is accurate...on ensuring coding is accurate and properly supported by clinical documentation within the health records, as well as… more
    WelbeHealth (09/19/25)
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  • Coding Data Quality Auditor

    CVS Health (Oklahoma City, OK)
    …to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical ... Coder) or CCS-P (Certified Coding Specialist-Physician) required. + CRC (Certified Risk Adjustment Coder) + Computer proficiency including experience with… more
    CVS Health (09/27/25)
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  • Quality Senior Analyst

    CVS Health (IL)
    …to the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical ... and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required.… more
    CVS Health (09/30/25)
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  • Quality Improvement CDI Specialist

    NCH (Naples, FL)
    …well as applicable organizational policies and procedures. * Experience in MS-DRG and APR-DRGs, risk adjustment , HACs and PSIs, O/E mortality, and LOS. * Working ... + DEPARTMENT: 17117 - Clinical Documentation Integrity + LOCATION: 350 7th Street...clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective… more
    NCH (09/15/25)
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  • Compliance Auditing Specialist- Remote/Hybrid…

    WMCHealth (Valhalla, NY)
    …Applicant link Job Details: Job Summary: Serves as an internal expert on Risk Adjustment and Hierarchical Conditions Categories (HCC) coding. Specific duties ... (CRC), Certified Professional Coder certification (CPC), Certified Professional Medical Auditor (CPMA) or Certified Clinical Documentation Specialist (CCDS)… more
    WMCHealth (09/12/25)
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  • Governance and Compliance Analyst

    RELX INC (Atlanta, GA)
    …of our GRC team? About the role: We are seeking an experienced Governance, Risk , and Compliance (GRC) Analyst to lead the development and implementation of our ... successful candidate will have a deep understanding of cybersecurity frameworks, risk management, and compliance standards, and will work collaboratively with… more
    RELX INC (08/31/25)
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