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Support activities to identify risk adjustment strategies and tactics, and then to implement the activity sets (Medicare, Medicaid, Exchange, and Commercial) Communicate and collaborate with medical coding team regarding risk adjustment projects.
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Executive level Health Actuary needed for highly visible position within growing Healthcare Provider, FSA designation, 10+ years of experience, experience in Medicare, Provider Contracting, and Risk Scoring.
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In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare and other populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care.
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Assign diagnostic and procedure codes for compliant physician reimbursement and for both evaluation/ management, preventive (HCC risk adjustment) and surgical services under general supervision.
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations.
$120,000 - $150,000 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Preferred Location: Hanover, MD.The Medicare Risk Adjustment Advanced Analytic Senior Is responsible for creating statistical models to predict, classify, quantify, and/or forecast business metrics.
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About Advantmed Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners.
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Develop automated processes to calculate Centers for Medicaid and Medicare Services (CMS) Hierarchical Condition Category (HCC) Risk Adjustment Factor (RAF) models (v24 and v28) and accurately calculate RAF scores for each member.
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Who Should Apply: If you have experience as a certified coder, medical coder, Medicare risk adjustment, CPC, CRC, medical coding specialist, remote coder, medical coding, MRA, HCC, hierarchal condition categories, or risk adjustment, we would love for you to apply.
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Develops, implements, and maintains auditing practices related to medical record coding and documentation to enhance risk adjustment outcomes for Medicare members. Certified Risk Adjustment Coder (CRC) preferred.
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Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
$18.5 - $35.29 an hourFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Ability to pass a background check and drug test Private, quiet, and distraction-free workspace in a room with a closed-door *We will also will accept someone with 3 years of non-risk adjustment coding experience as long as they have their CRC Consultant: Starting off as a consultant/contractor with no end date (almost all of the positions within this client start off as a contractor due to being a Fortune 100 company.
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This position will support Medicare Risk Adjustment activities including ACO REACH, MSSP and Medicare Advantage activities. Serves both internal and external customers, identifies opportunities for improvement throughout the Medicare risk adjustment process.
$100,000 - $231,500 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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The Clinical Documentation Improvement Specialist (CDIS) reviews inpatient medical records while patients are still in-house (concurrent review) for proper documentation resulting in appropriate reimbursement, severity of illness, risk of mortality, quality measures and risk adjustment.
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medicare risk adjustment jobs
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