- Highmark Health (Pittsburgh, PA)
- …+ Production Coding : Manage a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track production coding ... for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable...coding . Promotes the strategy and capabilities to develop risk management and physician / member initiatives that support… more
- Evolent (Helena, MT)
- …Be Doing:** **Manager, Coding Support Specialist** Evolent Care Partners is seeking a Risk Adjustment Coding Support Manager to be a core member of ... the Risk Adjustment Coding Support team....the Risk Adjustment Coding Support team. Evolent Care Partners'...coding questions and issues. + Collaborate with the coding director to develop policies, procedures, and… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Director Risk Adjustment Prospective...and assess the organization's risk related to risk adjustment coding and conduct ... adjustment exposure/ risk . Contributes to and approves Priority Health Risk Adjustment Coding Guidelines. + Serve as point person for relationships… 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, ... Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location:...* Responsible for developing and implementing risk adjustment strategies to facilitate accurate and complete coding… more
- Datavant (Augusta, ME)
- …on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent ... As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the...technology solutions. + Solid understanding of clinical suspecting, concurrent coding workflows, risk adjustment models… 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
- Providence (Portland, OR)
- …work mostly 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… more
- Ankura (New York, NY)
- …college/university + Current Registered Nurse license + Experience working for payors conducting risk adjustment reviews + Clinical experience in a variety of ... and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside… more
- Datavant (Olympia, WA)
- …strategic mindset and a focus on continuous improvement. + Familiarity with CMS HCC risk adjustment processes preferred \#LI-BC1 We are committed to building a ... experiences to realize our bold vision for healthcare. The Director of Client Success will report to the VP...departmental needs and organizational goals. + Partner with the coding operations, coding quality, data integration, product,… more
- University of Utah Health (Murray, UT)
- …clinical, coding , and IT teams to ensure compliance, optimize risk adjustment revenue, and help drive provider engagement interventions. **Qualifications** ... trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for...(eg, SAS, Python, R, Excel). + Familiarity with ICD-10-CM coding , HCC mappings, and risk score calculations.… more
- Hartford HealthCare (Farmington, CT)
- …Knowledge of ICD 10 Diagnostic and CPT coding regulations and guidelines and risk adjustment coding * Extensive knowledge of state, federal and Medicare ... Heart and Vascular, Orthopedics and Tallwood Urology & Kidney. Position Summary: The Director of Professional Services Coding will provide system wide leadership… more
- Commonwealth Care Alliance (Boston, MA)
- …data, including claims, encounters, diagnoses, and provider data. + Familiarity with CMS risk adjustment methodologies and HCC coding preferred. + Experience ... Director of Encounter Data Management within the Revenue Cycle Department, the Risk Adjustment Data Developer is responsible for the design, development, and… more
- Penn Medicine (Bala Cynwyd, PA)
- …of relevant coding medical professional services experience including ambulatory outpatient and risk adjustment coding . (Required) + Certified Risk ... Hospice- 150 Monument Road** **Hours: Full-Time** **Job Summary:** The Ambulatory Coding and Documentation Specialist reports to the Primary Care Service Line,… more
- HCA Healthcare (Nashville, TN)
- … coding and documentation improvement education to Providers. + Assists the Director Coding Operations Division Support in reviewing progress against business ... Coder (CPC(R)) credential or Certified Professional Coder - Hospital (CPC-H(R)) or Certified Risk Adjustment Coder (CRC) EXPERIENCE: + Experience with Cerner and… more
- HCA Healthcare (Nashville, TN)
- … coding and documentation improvement education to Providers. + Assists the Director Coding Operations Division Support in reviewing progress against business ... Coder (CPC(R)) credential or Certified Professional Coder - Hospital (CPC-H(R)) or Certified Risk Adjustment Coder (CRC) EXPERIENCE: + Experience with Cerner and… more
- AdventHealth (Tampa, FL)
- …and approved coding policies and procedures. . Participates in the mortality/ risk adjustment reviews when assigned. . Assists with post-payment DRG appeals. ... a Primary Stroke Center. **The ro** **le you'll contribute:** The Inpatient Coding Quality Auditor, under general supervision of the Inpatient Operations Manager, is… more
- Humana (Phoenix, AZ)
- …analyze large data sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment , pharmacy knowledge a plus + Certified Coder (CPC, CRC, ... to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align… more
- Scripps Health (San Diego, CA)
- …Categories (HCCs) for accuracy and compliance as relates to Outpatient CDI. Monitors Risk Adjustment Factor (RAF) Scores. * Directs instructions and education ... This Senior Director position is eligible to participate in the...you will have primary accountability for the oversight of Coding , Clinical Documentation Integrity (CDI) and Health Information Management… more
- Elevance Health (Cincinnati, OH)
- …Capabilities and Experiences:** + Deep understanding of CMS-HCC and/or HHS-HCC risk adjustment methodologies strongly preferred. + Experience partnering with ... **Clinical Compliance Medical Director ** _Please note that per our policy t_...regulatory, compliance, and legal matters strongly preferred. + Certified Risk Adjustment Coder (CRC) or similar credential… more
- Elevance Health (Waukesha, WI)
- …and claims integrity. This leader brings proven experience in payer and provider risk adjustment initiatives and possesses a deep understanding of end-to-end ... **Clinical Documentation and Claims Integrity Director ** **Location:** **Virtual:** This role enables associates to...services enablement company-and is well-versed in Medicare and Medicaid risk adjustment policies, RADV auditing, and the… more