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Risk Adjustment Data Processor Jobs

Adjustment Clerk Jobs
By Culligan International At Rosemont, IL, United States
SAP / ERP data management experience strongly preferred
We offer competitive compensation & benefits including:
Associates Degree, Bachelor’s preferred but not essential, or equivalent additional work experience
3-7+ years of relevant experience in Accounting / Bookkeeping / Accounts Customer Service required
Intermediate Microsoft Excel skills, with ability to create pivot tables
Own the creation of customer billing that flows through the Culligan NA Customer Service Team
Risk Adjustment Medical Coder
By CSI Companies At United States
Strong clinical knowledge related to chronic illness diagnosis, treatment and management
100% REMOTE - Work from home
Long term contract position- Benefits Offered!
What other skills/experience would be helpful to have?
Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements
Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC
Program Coordinator, Risk Adjustment
By Oscar Health At United States
Support your manager by guiding decisions on an ongoing basis
3+ years of experience in Healthcare Operations
2+ years of experience with being held to and accomplishing goals
Experience / background in a fast-paced operations environment
Experience managing several critical, deliverables simultaneously
Maintain a strong grasp of our inventory and deliverables to ensure we are keeping/exceed pace against goal
Program Manager, Risk Adjustment
By Cotiviti At , Remote $100,000 - $121,000 a year
Deep knowledge of Project Management
A minimum of 3 years of successful client/program management.
Produces and manages documents related to client projects, calls, meetings, product specifications, special initiatives and follow up.
Fully accountable for ensuring that open issues are managed in a timely manner and that no key milestones are missed.
Completes all responsibilities as outlined on annual Performance Plan.
A minimum of 2 years of experience in Risk Adjustment space.
Remote Risk Adjustment Data Intake Specialist
By Cherokee Federal At , Washington, 20001
Effective time management skills to prioritize tasks, manage workloads, and meet project deadlines in a fast-paced development environment.
Evaluate and intake medical records and cover sheets for data entry within the CDAT-M system
Check submissions to ensure they meet requirements
Reports operational concerns to manager for Quality Improvement of daily processes
Demonstrates knowledge of various document types - e.g. paper records and electronic records
1-year minimum administrative work experience, including typing
Risk Adjustment Coder (Remote)
By Fidelis Care At New York, United States
Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines.
Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines.
Understands the impact of ICD-10 codes on the CMS HCC risk adjustment model.
Ability to meet productivity and accuracy standards.
Ability to defend coding decisions to both internal and external audits.
Performs other duties as assigned.
Associate, Regulatory Compliance (Risk Adjustment) - Remote
By Oscar Health At United States
Research to maintain a working knowledge of the RA regulations; interpret and apply the requirements across the enterprise.
Professional Academy of Healthcare Management (PAHM)
Work with other department leaders/managers to ensure risk adjustment (RA) compliance is monitored and practices are following industry standards.
Bachelor’s Degree or 4 years commensurate work experience.
3+ years’ experience in health plan RA compliance, regulatory affairs, government affairs, or a similar field..
Prior experience working with regulators on RA audits, compliance audits, reporting and other matters.
Risk Adjustment Program Coordinator
By Common Ground Healthcare Cooperative At Brookfield, WI, United States
Assist with communicating status of risk adjustment program to management and identify risks that require escalation
3 or more years of experience in health insurance
Strong interpersonal skills and high level of professionalism
Effective listening and critical thinking skills
Knowledge of ACA Marketplace and Risk Adjustment principles
Effective written and verbal communication skills
Risk Adjustment Auditor Jobs
By Privia Health At United States
Five-plus years of provider education experience
Monitor provider documentation after education; re-educate as needed
Prepare formalized reports from audit and education results
Provide monthly HCC education for the Audit and Education teams based on audit findings and risk
Communicate and problem-solve with senior department managers about specific HCC documentation and coding issues, and training needs
Bachelor's degree and/or relevant work experience preferred
Business Analyst, Risk Adjustment
By Oscar Health At United States
Support your manager by guiding decisions and implementation on an ongoing basis
3+ years of experience in Business Strategy or Healthcare Analytics
2+ years of related work experience in healthcare
SQL (or related) data experience
Experience with ROI, sizing, and valuation analysis
2+ years of experience with implementing strategic initiatives
Medicare Risk Adjustment Coding Specialist
By American Health Plans Inc. At Nashville Metropolitan Area, United States
• Escalate appropriate coding audit issues to management as required
• Strong organizational skills; ability to time manage effectively
o 2 years’ experience in managed healthcare environment related to claims and/or coding audits
o Significant HCC experience (including knowledge of HCC mapping and hierarchy)
• Knowledgeable of coding/auditing claims for Medicare and Medicaid plans
• Extensive knowledge of ICD-9 & ICD-10 diagnostic coding and auditing
Risk Adjustment Data Analyst
By Honest Medical Group At United States
Work closely with performance management and reporting teams to provide data and reporting necessary for practice and provider scorecards.
Advanced data manipulation skills, with 3+ years of SQL experience
Advanced MS Excel skills, with 3+ years experience
Medicare and/or Risk Adjustment experience/knowledge preferred
Work closely with internal teams (Actuarial, Health Economics, and Finance) to provide data and insights necessary for financial forecasts and projections.
Perform other related responsibilities as assigned.
Program Manager - Risk Adjustment
By Molina Healthcare At United States
Required Experience/Knowledge, Skills & Abilities
3-5 years of Program and/or Project management experience.
5-7 years of Program and/or Project management experience.
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Focuses on process improvement, organizational change management, program management and other processes relative to the business.
Leads and manages team in planning and executing business programs.
Qa - Risk Adjustment Rn
By The Judge Group At United States
Bachelor’s Degree or equivalent combination of education and experience
Continues education to maintain high level of proficiency in Risk Adjustment field.
Maintains RN and CRC certifications.
Executes other responsibilities per business needs.
Must have minimum of 3 years of clinical experience as a Registered Nurse (RN)
Must have Certified Risk Adjustment Coder (CRC)Certification
Coder 1-Risk Adjustment Jobs
By Loma Linda University Health At , , Ca

- Managed Care (Remote/Hybrid, Full-Time, Day Shift) -

Supervisor, Risk Adjustment & Quality
By Wellvana At , Remote
Experience in physician documentation/coding education. Experience in educating/training coders. ICD-10-CM Coding knowledge.
4+ years of experience in provider education
Knowledge of Medicare Advantage and other HCC entity program coding requirements.
Perform audits, coding, and provider education as per business needs
Experience working with ACO/ Health Plan
Minimum of 5 years’ experience in HCC-specific coding/auditing.
Project Manager Risk Adjustment- Remote U.s.
By CVS Health At , , Ct $60,300 - $130,000 a year

This position is responsible for provider/vendor/network outreach, production management, and reporting for the Risk Adjustment Retrospective Program for ACA, Medicare, MMP and DSNP lines of ...

Risk Adjustment Analyst Sr (Remote; Medicaid Encounters)
By Baylor Scott & White Health At , Remote $36.26 an hour
EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
Monitors and oversees the end-to-end claims encounter management workflow.
Immediate eligibility for health and welfare benefits
EXPERIENCE - 3 Years of Experience
EXPERIENCE- Medicaid Encounters experience preferred; certified coder preferred
Our competitive benefits package includes the following
Manager, Data Risk Office Programs
By Bristol Myers Squibb At , Princeton, Nj
At least 4+ years of privacy program management, compliance, or strong project management experience preferred.
Recognized privacy certifications and experience preferred.
anager Data Risk Office Program Management
Triage, route, track, and manage the status, ownership, and completion of privacy program tasks relating to the program.
Experienced in configuring and working with various industry leading data and privacy tools like OneTrust, TrustArc etc.
Preferred experience with working in a multi-cultural, multi-location and diverse environments.
Manager, Medical Risk Adjustment Analytics
By CareSource At , Remote $87,000 - $152,300 a year
Minimum of three (3) years of professional level experience performing a broad range of data analysis and management required
Managed care or healthcare experience is preferred
Ability to interact with executive levels of management as well as external stakeholders
Leads triage and overall prioritization of Finance Information Technology needs using both direct reports and dedicated IT staff.
Identify and develop strategies for the application of emerging technology to Finance related problems.
Manage key vendor relationships in support of the work being completed