- 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
- MedKoder (Mandeville, LA)
- …that offers a flexible schedule. Description: MedKoder, LLC is seeking a remote Professional HCC Risk Adjustment Coder who will apply both technical and ... regulations while identifying opportunities for increased financial success. The HCC Risk Adjustment Coder provides...ICD-10 codes based on documentation, ensuring compliance with CMS risk adjustment and quality guidelines.… more
- Datavant (Columbus, OH)
- …using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical ... to realize our bold vision for healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical...in a fast paced production environment while maintaining high quality . + Must be able to follow instructions, meet… 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
- UNC Health Care (Chapel Hill, NC)
- …the health and well-being of the unique communities we serve. Summary: The Risk Adjustment Coordinator will be responsible for analyzing and auditing medical ... payer under the value care contracts. In addition, the Risk Adjustment Coordinator will be responsible for...the EPIC WQ to reorder the Hierarchical Condition Categories ( HCC ) conditions in the top 12 for claim generation.… more
- HCA Healthcare (Campbell, CA)
- …and integrity. We care like family! Jump-start your career as a(an) Manager of Quality - Risk Adjustment Programs today with HCA Healthcare. **Benefits** ... Eligibility for benefits may vary by location._** Come join our team as a(an) Manager of Quality - Risk Adjustment Programs. We care for our community! Just… 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 ... and coding policies to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the… more
- Commonwealth Care Alliance (Boston, MA)
- …systems and tools that support Commonwealth Care Alliance's (CCA) risk adjustment and Hierarchical Condition Category ( HCC ) revenue programs. This position ... data solutions. + Develop and support risk adjustment financial models that align with HCC ...+ Maintain and enhance reporting infrastructure to track data quality , submission errors, and risk score performance.… more
- Datavant (Trenton, NJ)
- …and life experiences to realize our bold vision for healthcare. We're looking for a Risk Adjustment Trainer to help us uplevel our Risk Adjustment ... HCC mapping and models + Experience with coding Medicare, Commercial and Medicaid risk adjustment charts + Understanding of Medicare, Commercial and Medicaid … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …role will be responsible for representing Blue Cross Blue Shield MA's risk adjustment documentation and coding improvement initiatives through engagement with ... relationships with assigned providers / provider offices to improve risk adjustment coding and documentation accuracy and...conjunction with CRC preferred + Must pass pre-hire examination HCC /diagnosis coding + Must maintain 95% quality … more
- MVP Health Care (Schenectady, NY)
- …of Hierarchical Condition Categories ( HCC )s and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare ... Professional, Risk Adjustment Analyst Headquarters Office, 625...a passion for strategic engagement, data analytics, and healthcare quality improvement. **What's in it for you:** + Growth… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Risk Adjustment Coding & Chart Coordinator will be responsible for a number of key ... elements that drive success in the CDPHP Risk Adjustment programs. This includes, but is not limited to, medical record retrieval, transmission of medical… 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 ... both formally and informally, regarding the impact of documentation on patient care, quality metrics, risk adjustment , and correct reimbursement. Adheres to… more
- ZoomCare (Portland, OR)
- …initiatives. + Strong understanding of healthcare systems, value-based care models, and risk adjustment . + Proven track record of driving change, improving ... across ZoomCare's primary care operations, driving performance in key clinical quality metrics, Hierarchical Condition Category ( HCC ) coding recapture, and… more
- LifePoint Health (Las Cruces, NM)
- … mechanics and premium-based payment methodologies. Familiar with patient and practice risk adjustment mechanics, APR; HCC /RAF Familiar with conventional ... In 2019 and 2020, insurance payers have been establishing databases and collecting quality data on MPP providers to position and leverage MPP towards quality… more
- Marshfield Clinic (Marshfield, WI)
- …external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the ... coding accuracy. The Educator develops and implements strategic action, quality improvement and risk management plans. The...accuracy and integrity of risk adjustment data submitted to the Centers… more
- Apex Health Solutions (Houston, TX)
- …knowledge of Electronic Health Records (EHR) Experience Minimum of three (3) years HCC experience performing retrospective risk adjustment chart review ... Specialist Supervisor: Director, VBC Operations Required License(s)/ Certification(s): Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC),… 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
- 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 ICD-10 diagnosis coding conventions and requirements, knowledge of Quality Coding Program requirements such as the Medicare Advantage Coding Program/… 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 ICD-10 diagnosis coding conventions and requirements, knowledge of Quality Coding Program requirements such as the Medicare Advantage Coding Program/… more