- Excellus BlueCross BlueShield (Buffalo, NY)
- …see is right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of ... diagnosis coding . This position is responsible for risk adjustment coding and quality...Medicare Advantage and Commercial Hierarchical Condition Category (HCC) coding , and Medicaid Clinical Risk Groups (CRGs)… more
- Trinity Health (Syracuse, NY)
- …Ability to conduct Education if needed. Auditing Experience Posting POSITION PURPOSE: The Risk Adjustment Coding Specialist works in a team environment ... to their next visit. . HCC education and training will be conducted per Excellus payer risk adjustment coding guidelines and required of all PCPs within the… 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
- UPMC (Pittsburgh, PA)
- …for coding (EPIC, Cerner, Clinical Connect, Document Viewer and Internal Risk Adjustment Coding Programs). + Detail-oriented individual with excellent ... members. Provides audit and coding related support to the internal Risk Adjustment Department. **Responsibilities:** + Utilize standard coding … more
- Highmark Health (Pittsburgh, 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
- Datavant (Trenton, NJ)
- …and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of health insurance plans operations + Deep… more
- CareOregon (Portland, OR)
- …and prepares various production and ad hoc reports aligned with risk adjustment initiatives and strategies for both the Medicare and Medicaid lines of ... Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Risk Adjustment Analyst Department Finance Exemption Status...and reliability. + Calculate risk scores and risk score related reporting for both the Medicare… more
- MVP Health Care (Schenectady, NY)
- …interventions for improved coding for Medicaid members. Calculates ROIs for Risk Adjustment programs. + Maintain regulatory agency requirements for CMS and ... Professional, Risk Adjustment Analyst Headquarters Office, 625...Medicare and commercial exchange populations. + Use Clinical Risk Group (CRG) software to target… more
- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Risk Adjustment Compliance Professional 2 supports the organization's adherence to governmental ... and contractual requirements, with a focus on risk adjustment operations. The role involves varied...and maintaining of compliance policies and procedures related to risk adjustments activities, including coding accuracy, encounter… more
- CenterWell (Des Moines, IA)
- …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
- 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 ... Manager (CPPM) 4. Certified Professional Biller (CPB) 5. Certified Risk Adjustment Coder (CRC). Experience: + Three...coding /medical billing is required. + Working knowledge of Medicare and Medicaid is required. + Available to travel… more
- Trinity Health (Boise, ID)
- …Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder education. Conducts ongoing ... and procedures; and ensuring proper assignment of diagnosis and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid… 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. ... detail. Efficient. Flexibility. High work ethic. Team building. Preferred: Knowledge of Medicare and other government or third-party coding rules. Working… 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 ... & Kidney. Position Summary: The Director of Professional Services Coding will provide system wide leadership and strategic direction...Medicare regulations related to coding * Knowledge of the revenue cycle for the… 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
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... also oversee the improvement of clinical documentation accuracy for Medicare and Exchange members. While under the direction of...in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving… more
- Fairview Health Services (St. Paul, MN)
- …provider documentation for clinical conditions and procedures to reflect severity of illness, risk adjustment , accurate coding , accuracy of patient outcomes, ... informally, regarding the impact of documentation on patient care, quality metrics, risk adjustment , and correct reimbursement. Adheres to departmental and… more
- Hartford HealthCare (Farmington, CT)
- …documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the ... documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding ...five years' work experience with CPT, HCPCS and ICD-10 coding conventions required. Experience with interpreting Medicare ,… more
- Insight Global (Tampa, FL)
- …an active Coding certification (CPC) through AAPC or AHIMA, or a CCS. Will be coding more risk adjustment vs profee. Most of the markets are strictly ... Job Description Insight Global is hiring a HCC/ Risk Adjustment Coder that has a...certification to support a backlog for inpatient and outpatient Medicare advantage projects. Will be expected to meet high… 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 ... educational and training resource materials to assist providers in coding accuracy. The Educator develops and implements strategic action,...and integrity of risk adjustment data submitted to the Centers for … more