CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist) * Willingness to travel up to 10% ...
CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist) * Willingness to travel up to 10% ...
Risk Analyst
Stamford, CT · On-site
... Traders, Trading Assistants, as well as Accounting, Distribution, and Treasury Depts ... and posts adjustments and/or reserves • Understands and reports P&L and MTM attributes and ...
Risk Analyst
Stamford, CT · On-site
... Traders, Trading Assistants, as well as Accounting, Distribution, and Treasury Depts ... and posts adjustments and/or reserves • Understands and reports P&L and MTM attributes and ...
Risk Analyst
Stamford, CT · On-site
... Traders, Trading Assistants, as well as Accounting, Distribution, and Treasury Depts ... and posts adjustments and/or reserves · Understands and reports P&L and MTM attributes and ...
Risk Analyst
Stamford, CT · On-site
... Traders, Trading Assistants, as well as Accounting, Distribution, and Treasury Depts ... and posts adjustments and/or reserves · Understands and reports P&L and MTM attributes and ...
Staff Auditor
Middletown, CT · On-site
... risk assessment practices. The Staff Auditor will have the following primary responsibilities ... Perform or assist with execution of individual audits across lines of business or functions. Ensure ...
Staff Auditor
Middletown, CT · On-site
... risk assessment practices. The Staff Auditor will have the following primary responsibilities ... Perform or assist with execution of individual audits across lines of business or functions. Ensure ...
Staff Auditor
Middletown, CT · On-site
... risk assessment practices. The Staff Auditor will have the following primary responsibilities ... Perform or assist with execution of individual audits across lines of business or functions. Ensure ...
Staff Auditor
Middletown, CT · On-site
... risk assessment practices. The Staff Auditor will have the following primary responsibilities ... Perform or assist with execution of individual audits across lines of business or functions. Ensure ...
Senior Internal Auditor
Hartford, CT · On-site
$85K - $105K/yr
... America entities to assist Senior Management in the achievement of the Company's strategic ... Independently or through guiding assigned audit staff, conducts risk analysis, control ...
Senior Internal Auditor
Hartford, CT · On-site
$85K - $105K/yr
... America entities to assist Senior Management in the achievement of the Company's strategic ... Independently or through guiding assigned audit staff, conducts risk analysis, control ...
Senior Internal Auditor
Hartford, CT · Hybrid
$85K - $105K/yr
... America entities to assist Senior Management in the achievement of the Company's strategic ... Independently or through guiding assigned audit staff, conducts risk analysis, control ...
Senior Internal Auditor
Hartford, CT · Hybrid
$85K - $105K/yr
... America entities to assist Senior Management in the achievement of the Company's strategic ... Independently or through guiding assigned audit staff, conducts risk analysis, control ...
Senior Internal Auditor
Hartford, CT · On-site
$85K - $105K/yr
Under the direction of the Assistant Director of Internal Audit, theSenior Internal Auditor is ... Risk-Based Planning: Leads the development of individual audit programs by identifying high-risk ...
Senior Internal Auditor
Hartford, CT · On-site
$85K - $105K/yr
Under the direction of the Assistant Director of Internal Audit, theSenior Internal Auditor is ... Risk-Based Planning: Leads the development of individual audit programs by identifying high-risk ...
Senior Internal Auditor
Hartford, CT · On-site
$85K - $105K/yr
Under the direction of the Assistant Director of Internal Audit, the Senior Internal Auditor is ... Risk-Based Planning: Leads the development of individual audit programs by identifying high-risk ...
Quick apply
Senior Internal Auditor
Hartford, CT · On-site
$85K - $105K/yr
Under the direction of the Assistant Director of Internal Audit, the Senior Internal Auditor is ... Risk-Based Planning: Leads the development of individual audit programs by identifying high-risk ...
Sr. IT Auditor
$93K - $122K/yr
Company Description North Star Staffing Solutions The Senior IT Auditor will assist audit teams in ... Develop detailed risk assessment, audit planning memos, + audit programs based upon an ...
Sr. IT Auditor
$93K - $122K/yr
Company Description North Star Staffing Solutions The Senior IT Auditor will assist audit teams in ... Develop detailed risk assessment, audit planning memos, + audit programs based upon an ...
Staff Auditor
New Haven, CT · On-site
... and dates. * Assist in the documentation of audit programs, risk assessments, work papers, and ... Complete operational, financial, and technology audits following professional auditing and ...
Staff Auditor
New Haven, CT · On-site
... and dates. * Assist in the documentation of audit programs, risk assessments, work papers, and ... Complete operational, financial, and technology audits following professional auditing and ...
We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand ... You Must Also Be Able To Mentor New Hires And Provide Support To Assistant Client Services ...
We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand ... You Must Also Be Able To Mentor New Hires And Provide Support To Assistant Client Services ...
Sr. Surety Quality Auditor
Hartford, CT · On-site
We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand ... You Must Also Be Able To Mentor New Hires And Provide Support To Assistant Client Services ...
Sr. Surety Quality Auditor
Hartford, CT · On-site
We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand ... You Must Also Be Able To Mentor New Hires And Provide Support To Assistant Client Services ...
... engagements. Assist in preparing risk assessments and audit plans for clients. Drafting or ... Certified CIA or other standard auditing certification combined with solid Internal Audit ...
... engagements. Assist in preparing risk assessments and audit plans for clients. Drafting or ... Certified CIA or other standard auditing certification combined with solid Internal Audit ...
... program * Assist with development and maintenance of registries, care management and other ... EMR, risk adjustment, disease registry and care management) * Strong writing, analytical and ...
... program * Assist with development and maintenance of registries, care management and other ... EMR, risk adjustment, disease registry and care management) * Strong writing, analytical and ...
... program * Assist with development and maintenance of registries, care management and other ... EMR, risk adjustment, disease registry and care management) * Strong writing, analytical and ...
... program * Assist with development and maintenance of registries, care management and other ... EMR, risk adjustment, disease registry and care management) * Strong writing, analytical and ...
Senior Financial Internal Auditor - Hybrid
Bloomfield, CT · On-site
$84K - $104K/yr
Develop risk-based audit programs and monitor remediation of identified issues to closure. * Build ... improvements. * Assist team members with issues requiring financial or technical expertise.
Senior Financial Internal Auditor - Hybrid
Bloomfield, CT · On-site
$84K - $104K/yr
Develop risk-based audit programs and monitor remediation of identified issues to closure. * Build ... improvements. * Assist team members with issues requiring financial or technical expertise.
Senior Financial Internal Auditor - Hybrid
Bloomfield, CT · On-site +1
$84K - $104K/yr
Develop risk-based audit programs and monitor remediation of identified issues to closure. * Build ... improvements. * Assist team members with issues requiring financial or technical expertise.
Senior Financial Internal Auditor - Hybrid
Bloomfield, CT · On-site +1
$84K - $104K/yr
Develop risk-based audit programs and monitor remediation of identified issues to closure. * Build ... improvements. * Assist team members with issues requiring financial or technical expertise.
... risk adjustment * Has strong interpersonal skills to collaborate with clinicians, physicians, NP ... Bachelor's degree in nursing, medical degree, or physician assistant required * Current Registered ...
... risk adjustment * Has strong interpersonal skills to collaborate with clinicians, physicians, NP ... Bachelor's degree in nursing, medical degree, or physician assistant required * Current Registered ...
Director - Tax Planning, Audits &Risk Mgmt
Orange, CT · On-site +1
Member of the Avangrid Tax leadership team, responsible to assist in the development of overall ... auditors, and global teams. * Applies strong analytical judgment to evaluate tax positions and ...
Director - Tax Planning, Audits &Risk Mgmt
Orange, CT · On-site +1
Member of the Avangrid Tax leadership team, responsible to assist in the development of overall ... auditors, and global teams. * Applies strong analytical judgment to evaluate tax positions and ...
Assistant Risk Adjustment Auditor information
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$75K - $165K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 3 days ago
CVS Health rating
5.8
Based on 4,316 frontline employees who took The Breakroom Quiz
87th of 109 rated pharmacies
Job description
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
Position Summary
As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.
The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.
Key Responsibilities
Lead the Medicare Advantage Risk Adjustment compliance program.
Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.
Assess operational processes for compliance risks related to risk adjustment activities.
Develop and implement corrective action plans for identified compliance issues.
Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.
Required Qualifications
Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance
Minimum 5 years in a leadership role
One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)
Willingness to travel up to 10% (including by plane)
Preferred Qualifications
Health Information Management (RHIA/RHIT)
Nursing - Strong understanding of clinical documentation and medical record review
Certified Risk Adjustment Coder (CRC) with compliance experience
Provider coding audit/compliance leadership experience
Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits
Education
Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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About CVS Health
Sourced by ZipRecruiter
Industry
Health care and social assistance and retail
Company size
10,000+ Employees
Headquarters location
Woonsocket, RI, US