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The Risk Adjustment Coder/Auditor works under the direct supervision of the Coding Manager and collaboratively with others in the organization, including ACO support staff, quality specialists, HIS team and clinical staff.
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Support chart audit processes, including audit provider and vendor documentation of ICD-9 and ICD-10 codes to ensure adherence with Center for Medicare & Medicaid Services (CMS) risk adjustment guidelines, and act as a liaison between internal departments and external entities on regulatory data validation audits (including CMS RADV and HHS RADV.
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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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Educate providers on risk adjustment: its purpose, CMS-HCC coding rules and guidelines, open condition reporting, identifying unreported conditions, proper documentation for MA, MSSP, ACO Reach, and DCE patients.
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AND a Certified Risk Adjustment Coder certification (CRC). Position responsibilities include overseeing risk capture performance, reporting and assisting with the following: coding, abstracting and analyzing/reviewing medical records for the PHO risk adjustment programs to ensure proper medical diagnoses are coded appropriately and that the members medical record documentation supports the codes accurately in accordance with CMS, CPT and ICD.10 guidelines.
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Support chart audit processes, including audit provider and vendor documentation of ICD-9 and ICD-10 codes to ensure adherence with Center for Medicare Services (CMS) risk adjustment guidelines, and act as a liaison between internal departments and external entities on regulatory data validation audits (including CMS RADV and HHS RADV.
$65,490 - $100,200 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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A strong understanding of non- Risk Adjustment functions such as Actuarial, Care Management, Accounting, Provider Contracting, Network Management, Product Development, etc., and how they impact Health Plan operations and financials.
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Must be passionate about healthcare quality and contributing to an organization focused on maintaining accuracy of coding and documentation to capture the true health status of our members thru risk adjustment initiatives.
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Certified Risk Adjustment Coder (CRC) designation 1 Year. to the Audit team to ensure compliance with the Centers for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS) risk adjustment data submission activities that support accurate medical record documentation, claim, pharmacy, and enrollment data transmission.
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The Associate Vice President (AVP), Stars and Risk Adjustment National Medical Director leads key strategic and operational functions. AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership.
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Oversee extracting and collecting diagnosis data from claims systems, submitting this data in the form of Medicare Risk Adjustment Processing System (RAPS) files to CMS in a timely manner, and oversee the RAPS record error correction processes.
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Reporting to the Senior Manager of Medicaid Risk Adjustment, the Market Manager of Medicaid Risk Adjustment will work closely with cross-functional leadership across the Medicaid business to establish and champion a local market culture committed to revenue integrity excellence.
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Oversee contracted vendor activities and overall performance in the areas of risk adjustment, coding improvement, chart review, and reconciliation. Work with IT and Actuarial staff to reconcile data with Medicare financials, forecast risk adjustment factors, and model impacts of potential payment changes.
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We’re seeking a Senior Data Scientist - Risk Adjustment who is passionate about having a positive societal impact and for using technology for good – solving issues of health inequity for communities that have been perennially underserved.
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The Sr Director, Risk Adjustment Strategy and Program Management works collaboratively with Florida Blue Medicare, Florida Blue, and GuideWell executives and leadership to lead risk adjustment strategy and process.
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Title: risk adjustment Company: Pophealthcare
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