- Tufts Medicine (Burlington, MA)
- …coding meets both established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive knowledge of overall ... to improve overall provider documentation as it pertains to coding and risk adjustment guidelines. Reviews medical records to determine if diagnostic… more
- Point32Health (Canton, MA)
- …this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD) including risk adjustment ... and timely resolution of production issues pertaining to CMS and risk adjustment data submission, including issue investigation, business requirements,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …across medical/pharmacy service categories, benchmarking methodologies, retention/leakage analytics, and Medicare risk adjustment + Solid understanding ... domains, including population health management, quality measurement and performance improvement, risk adjustment and coding, and product management and… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... + Contribute towards the maintenance and enhancement of an effective Compliance Risk Assessment Program + Project manage regulator and other external reviews as… more