Atlanta, GA · On-site
Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies. * Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.
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Atlanta, GA · On-site
Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies. * Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.
Atlanta, GA · Remote
$600 - $720/day
Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits * Review medical history, medications, preventive needs * Document visits using ICD-10 and CPT II ...
Atlanta, GA · Remote
$600 - $720/day
Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits * Review medical history, medications, preventive needs * Document visits using ICD-10 and CPT II ...
Atlanta, GA · On-site
$41.85/hr
Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease ...
Atlanta, GA · On-site
$41.85/hr
Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease ...
Atlanta, GA · On-site +1
... clinical pillars - Risk Adjustment, Care Management, Utilization Management, and Quality ... Familiarity with quality metrics, HCC coding, AWV workflows, annual wellness visit implementation ...
Atlanta, GA · On-site +1
... clinical pillars - Risk Adjustment, Care Management, Utilization Management, and Quality ... Familiarity with quality metrics, HCC coding, AWV workflows, annual wellness visit implementation ...
Atlanta, GA · On-site
... clinical pillars - Risk Adjustment, Care Management, Utilization Management, and Quality ... Familiarity with quality metrics, HCC coding, AWV workflows, annual wellness visit implementation ...
Atlanta, GA · On-site
... clinical pillars - Risk Adjustment, Care Management, Utilization Management, and Quality ... Familiarity with quality metrics, HCC coding, AWV workflows, annual wellness visit implementation ...
Kennesaw, GA · Hybrid
$74K - $112K/yr
... adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is ... HCC.Applying our Mind Over Risk philosophy to writing insurance allows our customers to take on ...
Kennesaw, GA · Hybrid
$74K - $112K/yr
... adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is ... HCC.Applying our Mind Over Risk philosophy to writing insurance allows our customers to take on ...
To excel in HCC Risk Adjustment, you need a solid understanding of medical coding, clinical documentation, healthcare regulations, and disease management, usually coupled with experience in coding certifications like CPC or CRC. Familiarity with Hierarchical Condition Category (HCC) models, data analytics tools, and electronic health record (EHR) systems is essential. Attention to detail, analytical thinking, and strong communication skills make a candidate stand out in this role. These skills ensure accurate risk adjustment coding and documentation, which are vital for appropriate reimbursement and compliance in the healthcare industry.
Professionals in HCC Risk Adjustment are typically responsible for reviewing medical records, ensuring accurate coding of diagnoses aligned with CMS guidelines, and collaborating with providers to improve documentation. The role often involves analyzing patient data to identify risk gaps and providing education to clinical staff on best practices for compliant coding. Team members regularly coordinate with data analysts, providers, and compliance teams to support accurate reporting and optimal reimbursement. Overall, attention to detail and clear communication are key to meeting the organization's compliance and financial objectives.
An HCC Risk Adjustment job involves reviewing medical records to ensure accurate coding of diagnoses under the Hierarchical Condition Category (HCC) model. This role helps determine risk scores for patients, which impact healthcare provider reimbursements in Medicare Advantage and other risk-adjusted programs. Professionals in this field, such as medical coders or auditors, analyze documentation to assign appropriate ICD-10-CM codes that reflect a patient's health status. Strong attention to detail and knowledge of coding guidelines are essential for success in this role.
Atlanta, GA • On-site
Contractor
Posted 20 hours ago
We are an Information Technology and Business Consulting firm specializing in Project-based Solutions and Professional Staffing Services. Please have a look at below position which is with our Client and let me know your interest ASAP. I would really appreciate if you could send me your MOST RECENT UPDATED RESUME:
Title: Business Analyst – Risk Adjustment (Payor)
Location: Richmond or Atlanta – Hybrid role
Long Term Contract || 1099 only || Need USC or GC only
Need strong Business Analyst – Risk Adjustment (Payor) with risk adjustment analytics in a healthcare payer environment (Medicare Advantage, ACA (HIX/Exchange), or Medicaid), SQL, Excel, data visualization tools (Tableau/Power BI/SAS), healthcare data formats (claims, encounters, EMR, lab, and eligibility), regulatory processes (CMS, HHS, EDGE server, RADV/IVA audits), HCC coding models (CMS-HCC, HHS-HCC), ICD-10 codes, and claims data Exp.
Consultant LinkedIn profile must have been created before 2018/2019
Need 8-10+yrs of IT Exp. Profiles
Job Summary:Client is seeking a highly analytical and motivated Business Analyst – Risk Adjustment to support risk adjustment operations and data analytics initiatives. This role is critical in helping ensure accurate and compliant capture of risk adjustment data for government-sponsored programs such as Medicare Advantage and ACA (HIX/Exchange). The candidate will play a key role in translating business needs into technical solutions, driving insights, and enabling optimized risk scoring strategies.Analyze and interpret risk adjustment data (claims, encounters, chart reviews, HCCs) to identify trends, data quality issues, and improvement opportunities.
Collaborate with stakeholders across actuarial, clinical coding, IT, and compliance teams to support risk score accuracy.
Translate regulatory and business requirements into user stories or functional specifications for data/reporting solutions.
Support CMS/HHS risk adjustment submission processes including EDGE server management and encounter reconciliation.
Assist in development and enhancement of dashboards/reports for risk score monitoring, suspecting models, and provider performance.
Monitor and interpret changes in CMS/HHS risk adjustment guidelines and apply to internal business processes.
Participate in audit support (e.g., RADV, IVA) and validation of risk adjustment data submissions.
Act as liaison between technical teams and business stakeholders to ensure delivery of actionable and scalable solutions.
Bachelor's degree in Healthcare Administration, Business, Analytics, or related field (Master’s preferred).
8+ years of experience in risk adjustment analytics in a healthcare payer environment (Medicare Advantage, Medicaid, or ACA).
Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies.
Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.
Proficiency in SQL and Excel; experience with BI tools like Power BI, Tableau, or SAS preferred.
Familiarity with regulatory processes (CMS, HHS, EDGE server, RADV/IVA audits).
Knowledge of data and reporting tools, including Cognos or Watson Health platforms.
Experience in Agile environments; ability to write and manage JIRA user stories and tasks.
Strong communication and stakeholder engagement skills across technical and business teams.
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11 - 50 Employees
Charlotte, NC, US
2004
