- Pyramid Consulting, Inc. (Tampa, FL)
- …audits Key Requirements and Technology Experience: Key Skills; Minimum 2 years in Risk Adjustment production coding Certification: CPC Production Coding ... Medicare Advantage Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of...Intermediate level CPC or CCS 2 years of medical coding experience, risk adjustment knowledge… more
- Advantmed (Portland, OR)
- …overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding , leading to greater value-based care. This ... network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at risk … more
- Healthcare in Action (Los Angeles, CA)
- …experiencing homelessness through an innovative "street medicine" approach by contracting with Medicare and Medicaid health plans as well as hospitals and health ... and parks. The Nurse (RN) supports members who are experiencing or are at risk of experiencing homelessness, managing their own health by providing direct care as a… more
- Navvis (Corvallis, OR)
- … discrepancies and improve documentation. Monitor key performance indicators related to HCC coding and risk adjustment . Provider Engagement & Collaboration: ... guidelines, best practices, and healthcare policy changes relevant to Medicare and Medicare Advantage patient populations. As...care models and payment methodologies. Strong understanding of HCC coding guidelines and risk adjustment … 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
- Highmark Health (Blue Bell, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... programs to ensure comprehensive and accurate diagnosis coding for risk adjusted government programs ( Medicare Advantage, ACA business, and Medicaid).… 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
