- Centene Corporation (Jefferson City, MO)
- … coding guidelines. + Validate clinical documentation to support appropriate risk adjustment coding , including Hierarchical Condition Categories (HCCs), ... clinical chart reviews and advise on clinical best practices related to risk adjustment coding , HCC capture, and documentation improvement. + Performs other… more
- Datavant (Madison, WI)
- …bold vision for healthcare. We're looking for experienced and credentialed Auditing Team Lead, HCC Risk Adjustment Coding to become an integral part of our ... through the process if they agree the coder's initial coding was correct. + Answers coding questions...titles (eg, Software Engineer) rather than complex ones (eg, Senior Software Engineer). The range posted is for a… more
- Ankura (New York, NY)
- …Risk Adjustment data collection and submission activities as well as knowledge of Risk Adjustment coding requirements preferably with a Risk ... and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also support practice… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior ACA Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity ... key deliverables. Develop tracking and monitoring mechanisms for all Risk Adjustment and Coding programs....the Division. + Ability to work with and support Senior Management and to disseminate and summarize information into… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and ... key deliverables. Develop tracking and monitoring mechanisms for all Risk Adjustment and Coding programs....the Division. + Ability to work with and support Senior Management and to disseminate and summarize information into… more
- Centene Corporation (Jefferson City, MO)
- …+ 3+ years Audit, risk adjustment and/or compliance required + Risk Adjustment /HCC coding required + Medicare experience required + Demonstrated ... from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …to ensure data integrity, accuracy, completeness and adherence to leading practices in risk adjustment coding . * Identifies external partner opportunities, ... Your Responsibilities * Responsible for developing and implementing risk adjustment strategies to facilitate accurate and complete coding , reporting, and… more
- CareFirst (Baltimore, MD)
- …a critical role in the development and execution of the corporate risk adjustment strategy for the acquisition and coding of medical records. The role serves ... the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products.… more
- Humana (Helena, MT)
- …make an impact** **Required Qualifications** + 5+ years of experience in risk adjustment coding /auditing/education and provider relations/engagement + ... caring community and help us put health first** The Senior Coding Educator will work closely with...gained from actual experience of chronic condition documentation and coding audits, risk adjustment program… more
- Point32Health (Canton, MA)
- …identification of member health conditions. The Manager will build relationships and drive risk adjustment engagement with senior leaders at contracted ... The Manager will frequently present upon the effectiveness of risk adjustment initiatives and programs to both internal senior leaders and external… more
- Providence (Portland, OR)
- …remotely in the states of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you will be the ... cornerstone of our strategic vision. You will oversee risk adjustment programs, spearhead provider education, and enhance engagement to support value-based… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED. **Experience:** 5 years experience in risk adjustment coding , ambulatory coding and/or CRC ... integration of medical codes across policies and platforms. The Senior Coding Analyst partners with medical policy...Strategizes alternatives and solutions to maximize quality payments and risk adjustment . Translates from claim language to… more
- CenterWell (Jackson, MS)
- … leaders/coders) + Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, ... function or segment. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible...provider coding improvement opportunities, risk score trending and tracking. + Partners with MRA… more
- Geisinger (Danville, PA)
- …one Coding Certification required:--Certified Professional Coder - AAPC --Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC) ... Information Technician (RHIT) - American Health Information Management Association; Certified Risk Adjustment Coder - American Academy of Professional Coders… more
- St. Mary's Healthcare (Amsterdam, NY)
- …Demonstrated knowledge of ICD-10-CM/PCS, CPT/HCPCS coding , MS-DRGs, APR-DRGs, APCs, and risk adjustment . Certifications / Licensure: + RHIA, RHIT, or CCS ... factors permitted by law. Responsibilities: + Provide day-to-day leadership to coding teams across inpatient, outpatient and professional services. + Partner with… more
- Scripps Health (San Diego, CA)
- …Professional Coder) * Comprehensive understanding of*ICD, CPT, and HCPCS* coding systems,*MS-DRG/APR-DRG*methodologies, and* risk adjustment /HCC*principles. * ... *This Senior Director position is eligible to participate in the Director Incentive Plan.* *This position is in La Jolla and requires residence in San Diego County.… more
- Amazon (Boston, MA)
- …will provide proactive guidance for upcoming tech builds and roadmaps, work with senior leaders on acceptable business risk when applicable, and track ... diverse stakeholders; evaluate control effectiveness within AI; understand levels of potential risk and how to address them; provide in-depth consultation; and have… more
- AdventHealth (Maitland, FL)
- …in understanding professional and facility claims and managed care concepts such as risk adjustment , capitation, FFS, DRG, APG, APCs and other payment mechanisms ... (Monday, Wednesday, Thursday) on-site **The role you will contribute:** A Senior Medical Economics analyst is responsible for analyzing and evaluating financial… more
- Point32Health (NH)
- …claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment . In-depth health care reimbursement and managed care business ... Summary** Working under the direction of the Director or Senior Manager, the Senior Network Performance Analyst...and Reserving to ensure open communication relating to provider risk deals. + In-depth knowledge and understanding of managed… more
- Molina Healthcare (NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key… more