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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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Accountable for the overall integration, management and implementation of the Medicare Risk Adjustment Program across HCSC (i.e. network management, customer service, clinical services, information technology, and finance departments.
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Experience with Medicare, Medicaid and Retail/Small Group Risk Adjustment process. Monitor and summarizes progress of CMS Risk Adjustment projects and initiatives. Job SummaryThis position is responsible for the overall management and implementation of various initiatives including, but not limited to, Risk Adjustment Programs, Accountable responsibilities include the overall development, refinement, maintenance, monitoring and oversight of Medicare, Medicaid and Retail/Small Group risk adjustment initiatives and operations.
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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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Required Certification/Licensure: Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPC. Utilizes knowledge of official coding guidelines (ICD-10, CPT, HCPCs), Hierarchical Condition Categories (HCC), M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards, Risk Adjustment Factor (RAF) scoring, and AHIMA/ACDIS physician query brief.
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Job DescriptionWork Location - KansasJob SummaryThe AVP, Quality Improvement & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality for all lines of business, ensuring alignment of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert for the health plan.
$122,430.44 - $238,739.34 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The AVP, Quality Improvement & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality for all lines of business, ensuring alignment of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert for the health plan.
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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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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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In addition, shows advanced knowledge in Risk Adjustment programs and HCC coding and documentation guidelines. Duties: Primary Duties and Responsibilities:The Nurse Practitioner is responsible for assisting in the expedient multidisciplinary care of patients for Hoag Hospital and its affiliates, coordinating seamless patient care from admission through discharge.
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The American Academy of Professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) certification is required; Certified Professional Coder (CPC) Certification will be considered with Risk Adjustment/HCC Coding experience and willingness to obtain CRC within 1 year of employment.
$55,953 - $83,930 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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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Essential FunctionsManages the daily workflow of Risk Adjustment strategies, which includes submissions, technical processes, reconciliations, provider engagement, provider coding outreach, In-Home Health Assessment (IHA), chart retrieval, and coding.
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Knowledge of HEDIS and Risk Adjustment Coding is helpful. License and certifications:Certification Preferred Risk Adjustment Coding, Quality, Project Management. Coordination and Planning Coordinate the planning, and completion of projects and complex tasks needed to ensure the Guidewell Sanitas PHSO's successful performance in value-based arrangements Ensures all Affiliate providers are onboarded and understand the expectations, and resources available for success within the PHSO.
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Experience:Prior HCC/HHS experience with Medicare Risk Adjustment with three (3) years’ experience in medical coding. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”The Capital BlueCross Government Programs Risk Adjustment coding position is a unique position that combines knowledge and experience in risk adjustment coding, Medicare and Government regulations, Medicare Advantage risk adjustment model, HHS ACA risk adjustment models, and RADV and HRADV experience.
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Title: risk adjustment Company: Sanitas
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