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The Associate Director - Medicare Risk Adjustment will be responsible for the oversight of Humana's various Risk Adjustment Programs and ensure ongoing compliance with all applicable state and federal guidelines.
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CRC (Certified Risk Adjustment Coder) credential required. Expert knowledge of risk adjustment, Hierarchical Condition Category (HCC), medical terminology and medical chart review required.
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Job Description: Your responsibilities include: Collaborate with R&D PMO, R&D Finance and Corp Finance teams, and business stakeholders to gather and analyze requirements related to financial planning, analysis, reporting, and project portfolio management.
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Preferred Qualifications: Experience with Medicare Risk Adjustment, Hierarchical Condition Categories, coding, billing, and auditing; extensive Outpatient CDI and Risk Adjustment Coding knowledge.
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Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Risk Adjustment Coder (RAC), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required.
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Requirements:Coding certification required through AHIMA or AAPC (at least one of the below):Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)Certified Coding Specialist for Providers (CCS-P)Registered Health Information Management Technician (RHIT)5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred.
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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. 3+ years of experience in HEDIS record collection and risk adjustment (coding.
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Support solution architects translate IT strategy and reference architectures into domain specific architecture visions and reference models. Define and manage architecture IT roadmap for your domain in line with the IT strategy and overarching Enterprise Architecture roadmap.
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Retail Part-Time Store Associate, Fabletics (Domain NORTHSIDE - Austin, TX) page is loaded. Retail Part-Time Store Associate, Fabletics (Domain NORTHSIDE - Austin, TX) Retail Part-Time Store Associate, Fabletics (Domain NORTHSIDE - Austin, TX) page is loaded.
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Qualifications REQUIREDBachelor’s degree in health sciences, public health, healthcare administration or related field or Certified Medical Assistant (CMA) certification and five (5) years of experience in ambulatory settingCertified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) credential.
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CSI Companies Coding and Clinical Data Integrity Practice is immediately seeking a Risk Adjustment Coding Project Manager (Remote) for a contract position with one of our clients in the payer space.
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Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
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Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ICD-10 coding; review of various payer denial/rejection reports to identify areas for provider education.
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Certified Risk Adjustment Coder (CRC) required; Certified Clinical Documentation Specialist (CCDS) preferred. Expertise in CMS Risk Adjustment Data Validation (RADV) for Medicare Advantage Plans, and medical coding, including but not limited to E/M, ICD-10, CPT, and HCC coding preferred.
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Business Analyst with experience in Financial Crimes domain (ECRR(Enterprise Client Risk Reporting)/AML(Anti Money Laundering), KYC, Sanctions Screening (like OFAC) + Actimize tool exposure. Job Title: - BA with Financial crimes Domain Knowledge & Scrum Master exp.
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