- UnitedHealth Group (Eden Prairie, MN)
- …encounter response files (MAO-002, MAO-004) Experience in applying Medicare Advantage Risk Adjustment Methodologies such the CMS- HCC model (Hierarchical ... pipeline efficiency and reporting accuracy Conducting ad hoc analyses related to Medicare Risk Adjustment using SQL (SQL Server, Snowflake) and visualizing… more
- Memorial Healthcare System (Hollywood, FL)
- …Professional Coder, HCC - Hierarchical Condition Category Coder, CRC Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor. Working ... HCC - Hierarchical Condition Category Coder, CRC - Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.Additional Credential… more
- Insight Global (Tampa, FL)
- Job Description Insight Global is hiring HCC / Risk Adjustment Medical coders to support a backlog for inpatient and outpatient Medicare advantage projects ... vs profee. Most of the markets are strictly risk adjustment focusing on HCC ...HCC codes. These markets are still only reviewing Medicare Advantage members. I would say 20-30% of our… more
- UCLA Health (Los Angeles, CA)
- …with physician billing and/or coding, required + Three or more years of recent experience in CMS- HCC Risk Adjustment models V24 and V28, required + Three or ... Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment coding… more
- UCLA Health (Los Angeles, CA)
- …required + Solid understanding of common healthcare measurement frameworks and definitions, including Risk Adjustment HCC models from CMS, required + Strong ... Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... that support Commonwealth Care Alliance's (CCA) risk adjustment and Hierarchical Condition Category ( HCC ) revenue...ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment … more
- Datavant (Lincoln, NE)
- …+ **Domain Expertise:** Deep understanding of risk adjustment metrics, risk scoring methodologies and models (eg, CMS- HCC , HHS- HCC ). Well-versed in ... to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and… more
- Tufts Medicine (Burlington, MA)
- …Provides education and feedback to physicians on a regular basis in regard to Risk Adjustment Coding guidelines ( HCC /DxCG), as well as ICD-10-CM Guidelines ... the greater Boston region. **Job Overview** Under the director of the Director, Risk Adjustment Operations, performs accurate and timely reviews and validations… more
- Trinity Health (Syracuse, NY)
- …to conduct Education if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding ... and documentation in alignment with risk adjustment models, conducting audits with analysis...specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings… more
- Hartford HealthCare (Hartford, CT)
- …in a variety of settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds relationships, programs, and processes ... recognition programs and other common practices across the system. *JOB SUMMARY:* The Risk Adjustment Coder Educator develops and implements an enterprise-wide … more
- Marshfield Clinic (Marshfield, WI)
- …stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy ... and integrity of risk adjustment data submitted to the Centers for ...Terminology (CPT), and ICD‐9, ICD-10 and Hierarchical Condition Category ( HCC ) coding. **Preferred/Optional:** Bachelor of Science in Nursing. **EXPERIENCE**… more
- UPMC (Pittsburgh, PA)
- **UPMC Health Plan has an exciting opportunity for a Physician Educator position in the HCC Risk Adjustment department. This is a full time position working ... and documentation in the medical record and the various risk adjustment models of payment. The Physician...Plan. A general understanding of Health care insurance and Medicare managed care is highly preferred for this position,… more
- Sutter Health (Sacramento, CA)
- …HS Diploma or General Education Diploma (GED) **CERTIFICATION & LICENSURE:** + CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or ... knowledge of Quality Coding Program requirements such as the Medicare Advantage Coding Program/ HCC , as well as medical terminology and abbreviations of disease,… more
- Trinity Health (Boise, ID)
- …to local ministry and Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder ... and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS). Monitor's accuracy of centralized coder's charge… more
- Henry Ford Health System (Troy, MI)
- …processes within value-based reimbursement models and initiatives. Reporting to the Director, Risk Adjustment and Value-Based Payment, the Program Manager is ... to both departmental staff and multi-disciplinary teams. + Knowledge of Medicare , Medicaid, Blue Cross and other third-party payers billing and reimbursement… more
