- UnitedHealth Group (Eden Prairie, MN)
- …sources (EDS, medical claims, supplemental data) to support Medicare Advantage Risk Adjustment programs, coding accuracy, and clinical health outcomes. ... our finance, operations, accounting and clinical leads to identify coding gaps, assess opportunity, forecast, and analyze risk...and reporting accuracy Conducting ad hoc analyses related to Medicare Risk Adjustment using SQL… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior ... Director of Medicare Risk Adjustment and Analytics....to ensure complete and accurate medical record documentation and coding . The Program Manager will contribute to the development… more
- Memorial Healthcare System (Hollywood, FL)
- …Professional Coder, HCC - Hierarchical Condition Category Coder, CRC - Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.Additional ... Certified Professional Coder, HCC - Hierarchical Condition Category Coder, CRC Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.… more
- UnitedHealth Group (Eden Prairie, MN)
- …revenue assessment, predictive suspecting, program evaluations, and strategic guidance related to Medicare Advantage Risk Adjustment . The role also requires ... risk adjustment efforts across our enterprise, primarily focused on Medicare Advantage Risk Modeling. We are internal analytics partners who provide… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior ... Director of Medicare Risk Adjustment and Analytics....to ensure complete and accurate medical record documentation and coding . The Program Manager will contribute to the development… more
- UCLA Health (Los Angeles, CA)
- … Advantage Risk Adjustment , you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders, ... Coding Specialist (CCS) certification, required + A Certified Risk Adjustment Coder (CRC), required + Reliable...understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems required + Knowledge of Medicare … more
- UCLA Health (Los Angeles, CA)
- …and others. + Serve as a key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: ... Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful… more
- Blue KC (Kansas City, MO)
- …documentation and quality coding . + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state regulations are ... state and federal regulatory guidance for risk adjustment , audit and documentation and coding accuracy...+ Maintain expert knowledge of ACA risk adjustment regulations + Maintain expert knowledge of Medicare… more
- Trinity Health (Albany, NY)
- …compliance standards in our provider group. **SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:** Risk adjustment coding , provider auditing and clinical/education ... specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings...and REQUIRED CERTIFICATION, EDUCATION, LICENSURE AND EXPERIENCE INCLUDES:** + Risk Adjustment Coding - Certified… more
- Trinity Health (Syracuse, NY)
- …compliance standards in our provider group. **SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:** Risk adjustment coding , provider auditing and clinical/education ... specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings...and REQUIRED CERTIFICATION, EDUCATION, LICENSURE AND EXPERIENCE INCLUDES:** + Risk Adjustment Coding - Certified… 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 ... meets both established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive knowledge of overall ICD-10-CM … more
- Corewell Health (Grand Rapids, MI)
- …This position will evaluate and assess the organization's risk related to risk adjustment coding and conduct internal audits to improve compliance. ... risk adjustment exposure/ risk . Contributes to and approves Priority Health Risk Adjustment Coding Guidelines. + Serve as point person for… more
- CareFirst (Baltimore, MD)
- …Risk Adjustment oversees the outcomes and operations of risk adjustment across the organization within Medicare Advantage, Medicaid & ACA markets. The ... Risk Adjustment Director is responsible for strategic direction, leadership, establishing...physicians, internal stakeholders, and C-suite with a focus on coding data and analytics. + Experienced with effective physician/provider… 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 ... ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment ...encounters, diagnoses, and provider data. + Familiarity with CMS risk adjustment methodologies and HCC coding… more
- Datavant (Lincoln, NE)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and ... execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development of robust, scalable, and actionable analytics… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Director (Remote/Hybrid) **Cost Center:** 682891390 SHP-Strategic ... Shift:** 40 Normal (United States of America) **Job Description:** **JOB SUMMARY** The Risk Adjustment Revenue Director is a finance leader responsible for … more
- Centene Corporation (Tallahassee, FL)
- … risk adjustment and/or compliance. required + Previous experience in risk adjustment oversight and/or coding planning preferred + Demonstrated ... a team responsible for supporting key elements of the Risk Adjustment Compliance program with a focus...adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare … more
- Humana (Des Moines, IA)
- …support assignments. Performs computations. Typically works on semi-routine assignments. The Risk Adjustment Representative 2 ensures coding is ... caring community and help us put health first** The Risk Adjustment Representative 2 conducts quality assurance...diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies.… more
- Molina Healthcare (Albuquerque, NM)
- …**Knowledge/Skills/Abilities** * Assist in the daily operations of all aspects of risk adjustment data validation related activities, including, but not limited ... retrieval, file transmissions, and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, milestones… more
- CenterWell (Baton Rouge, LA)
- …clinical documentation. + Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, ... provider coding improvement opportunities, risk score trending and tracking. + Partners with MRA...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions.… more
