- UPMC (Pittsburgh, PA)
- …team members. Provides audit and coding related support to the internal Risk Adjustment Department. **Responsibilities:** + Utilize standard coding guidelines, ... the specified audit period or review time frame. + Participate in government Risk Adjustment Data Validation audits (RADV) conducting research of internal… more
- Insight Global (Tampa, FL)
- Job Description Insight Global is hiring a HCC / Risk Adjustment Coder that has a CPC or CCS certification to support a backlog for inpatient and outpatient ... 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
- Kelsey-Seybold Clinic (Pearland, TX)
- …or CPC (Certified Professional Coder) or CPC-A or CRC (Certified Risk Adjustment Coder) Preferred: N/A **Special Skills** Required: Analytical. ... **Responsibilities** To ensure the accurate coding of diagnoses which fall into the HCC model as required by CMS for Medicare Advantage plans. To ensure… 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
- Trinity Health (Syracuse, NY)
- …to the Supervisor, RA Coding & Audit . Key contributor duties related to CCD/ HCC and other Risk Adjustment capture initiatives, as needed. SKILLS, ... as part of the pre-visit and post-encounter workflows, including queries to support addressing HCC codes for Risk Adjustment before a claim is submitted… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …and guidelines (eg ICD-9-CM, ICD-10, CPT, HCPC) * Familiarity and understanding of CMS HCC Risk Adjustment coding, Medicaid CRG coding, and data validation ... / ICD-10-CM coding validation, monitoring plan specifications, Hierarchical Condition Category ( HCC ) assignment accuracy and Risk Adjustment Validation… more
- Datavant (Trenton, NJ)
- …and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... of complex and advanced ICD-10 and Hierarchical Condition Category ( HCC ) coding and documentation training programs including defining training... Medicare , Commercial and Medicaid risk adjustment business logic and coding +… more
- MVP Health Care (Schenectady, NY)
- …rate of Hierarchical Condition Categories ( HCC )s and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for ... Professional, Risk Adjustment Analyst Headquarters Office, 625...Medicare and commercial exchange populations. + Use Clinical Risk Group (CRG) software to target interventions for improved… more
- CenterLight Health System (NY)
- …on current performance. + Serves as a subject matter expert on Risk Adjustment Data Validation (RADV) audits from Medicare . + Perform random audits of coding ... + Review and analyze monthly financial reports submitted by Medicare related to diagnostic data. + Present HCC...Manager (CPPM) 4. Certified Professional Biller (CPB) 5. Certified Risk Adjustment Coder (CRC). Experience: + Three… more
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving...new business and growth opportunities. . Understanding of the CMS- HCC and ACA risk models and associated… 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
- Fairview Health Services (St. Paul, MN)
- …setting, including physician encounters and how physician documentation translates into ICD-10-CM and HCC risk adjustment for claims submission to meet ... documentation for clinical conditions and procedures to reflect severity of illness, risk adjustment , accurate coding, accuracy of patient outcomes, and… 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
- Sutter Health (Sacramento, CA)
- …+ HS Diploma or equivalent education/experience **CERTIFICATION & LICENSURE** + CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA ... 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