Nurse SME - Contingent
Millersville, MD · On-site
Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews ... Experience supporting government, commercial, or managed healthcare programs preferred. Salary ...
Nurse SME - Contingent
Millersville, MD · On-site
Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews ... Experience supporting government, commercial, or managed healthcare programs preferred. Salary ...
... management on provider sourcing, collaboration and contract execution. There is additional collaboration with various quality teams and risk adjustment to ensure alignment with quality and HCC ...
... management on provider sourcing, collaboration and contract execution. There is additional collaboration with various quality teams and risk adjustment to ensure alignment with quality and HCC ...
Primary Care Advanced Practitioner (NP/PA)
Lanham, MD · On-site
$120K - $140K/yr
You will provide direct patient care, manage chronic conditions, and promote wellness through ... 10, HCC), and risk adjustment. - Active, unrestricted state license and DEA registration ...
Primary Care Advanced Practitioner (NP/PA)
Lanham, MD · On-site
$120K - $140K/yr
You will provide direct patient care, manage chronic conditions, and promote wellness through ... 10, HCC), and risk adjustment. - Active, unrestricted state license and DEA registration ...
Primary Care Advanced Practitioner (NP/PA)
Lanham, MD · On-site
$120K - $140K/yr
You will provide direct patient care, manage chronic conditions, and promote wellness through ... 10, HCC), and risk adjustment. - Active, unrestricted state license and DEA registration ...
Quick apply
Primary Care Advanced Practitioner (NP/PA)
Lanham, MD · On-site
$120K - $140K/yr
You will provide direct patient care, manage chronic conditions, and promote wellness through ... 10, HCC), and risk adjustment. - Active, unrestricted state license and DEA registration ...
Nurse SME
Millersville, MD · On-site +1
$100K - $120K/yr
Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews ... Experience supporting government, commercial, or managed healthcare programs preferred. Salary ...
Nurse SME
Millersville, MD · On-site +1
$100K - $120K/yr
Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews ... Experience supporting government, commercial, or managed healthcare programs preferred. Salary ...
You will manage a panel of patients, focusing on prevention, chronic disease management, and acute ... ICD-10, HCC), and risk adjustment. - Active, unrestricted state medical license and DEA ...
You will manage a panel of patients, focusing on prevention, chronic disease management, and acute ... ICD-10, HCC), and risk adjustment. - Active, unrestricted state medical license and DEA ...
Nurse SME
Millersville, MD · On-site
Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews ... Experience supporting government, commercial, or managed healthcare programs preferred. Salary ...
New
Nurse SME
Millersville, MD · On-site
Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews ... Experience supporting government, commercial, or managed healthcare programs preferred. Salary ...
New
You will manage a panel of patients, focusing on prevention, chronic disease management, and acute ... ICD-10, HCC), and risk adjustment. - Active, unrestricted state medical license and DEA ...
Quick apply
You will manage a panel of patients, focusing on prevention, chronic disease management, and acute ... ICD-10, HCC), and risk adjustment. - Active, unrestricted state medical license and DEA ...
You will manage a panel of patients, focusing on prevention, chronic disease management, and acute ... ICD-10, HCC), and risk adjustment. - Active, unrestricted state medical license and DEA ...
You will manage a panel of patients, focusing on prevention, chronic disease management, and acute ... ICD-10, HCC), and risk adjustment. - Active, unrestricted state medical license and DEA ...
Primary Care Advanced Practitioner (NP/PA)
Lanham, MD · On-site
$120K - $140K/yr
You will provide direct patient care, manage chronic conditions, and promote wellness through ... 10, HCC), and risk adjustment. - Active, unrestricted state license and DEA registration ...
Primary Care Advanced Practitioner (NP/PA)
Lanham, MD · On-site
$120K - $140K/yr
You will provide direct patient care, manage chronic conditions, and promote wellness through ... 10, HCC), and risk adjustment. - Active, unrestricted state license and DEA registration ...
Director of Revenue Cycle Management
Baltimore, MD · On-site
$115K - $150K/yr
Porter is hiring a Director of Revenue Cycle Management to join our Team! Porter combines the power ... risk adjustment, and member experience. ABOUT THE ROLE Our organization operates in a payer ...
Director of Revenue Cycle Management
Baltimore, MD · On-site
$115K - $150K/yr
Porter is hiring a Director of Revenue Cycle Management to join our Team! Porter combines the power ... risk adjustment, and member experience. ABOUT THE ROLE Our organization operates in a payer ...
Director of Revenue Cycle Management
Baltimore, MD · On-site
$115K - $150K/yr
Porter is hiring a Director of Revenue Cycle Management to join our Team! Porter combines the power ... risk adjustment, and member experience. ABOUT THE ROLE Our organization operates in a payer ...
Quick apply
Director of Revenue Cycle Management
Baltimore, MD · On-site
$115K - $150K/yr
Porter is hiring a Director of Revenue Cycle Management to join our Team! Porter combines the power ... risk adjustment, and member experience. ABOUT THE ROLE Our organization operates in a payer ...
Porter is hiring a Director of Revenue Cycle Management to join our Team! Porter combines the power ... risk adjustment, and member experience. ABOUT THE ROLE Our organization operates in a payer ...
Porter is hiring a Director of Revenue Cycle Management to join our Team! Porter combines the power ... risk adjustment, and member experience. ABOUT THE ROLE Our organization operates in a payer ...
Manage specific assigned geographic areas and successfully drive the FUJIFILM HCC Risk Biomarkers sales through that community. As assigned interface with Senior Management teams from major IVD ...
Manage specific assigned geographic areas and successfully drive the FUJIFILM HCC Risk Biomarkers sales through that community. As assigned interface with Senior Management teams from major IVD ...
Regional Medical Director
Baltimore, MD · On-site
$250/hr
Provides advanced clinical leadership across medical management programs, integrating traditional ... Experience with Stars performance, risk adjustment education, or provider engagement * Experience ...
Regional Medical Director
Baltimore, MD · On-site
$250/hr
Provides advanced clinical leadership across medical management programs, integrating traditional ... Experience with Stars performance, risk adjustment education, or provider engagement * Experience ...
... management on provider sourcing, collaboration and contract execution. There is additional collaboration with various quality teams and risk adjustment to ensure alignment with quality and HCC ...
... management on provider sourcing, collaboration and contract execution. There is additional collaboration with various quality teams and risk adjustment to ensure alignment with quality and HCC ...
Primary Care NP/PA (Multilingual / East Asian Community Focused)
Catonsville, MD · On-site
$130K - $165K/yr
As part of a close-knit clinical team, you will provide comprehensive primary care services, manage ... Strong understanding of medical documentation, coding (ICD-10, HCC), and risk adjustment. * Active ...
Primary Care NP/PA (Multilingual / East Asian Community Focused)
Catonsville, MD · On-site
$130K - $165K/yr
As part of a close-knit clinical team, you will provide comprehensive primary care services, manage ... Strong understanding of medical documentation, coding (ICD-10, HCC), and risk adjustment. * Active ...
Senior Data Submissions Operations Associate
Nottingham, MD · On-site +1
$55K - $90K/yr
Proven experience in healthcare data submissions, medical record management, or health information operations, ideally in a Medicare Advantage or risk adjustment audit environment. * Strong attention ...
Senior Data Submissions Operations Associate
Nottingham, MD · On-site +1
$55K - $90K/yr
Proven experience in healthcare data submissions, medical record management, or health information operations, ideally in a Medicare Advantage or risk adjustment audit environment. * Strong attention ...
Primary Care NP/PA (Multilingual / East Asian Community Focused)
Catonsville, MD · On-site
$130K - $165K/yr
As part of a close-knit clinical team, you will provide comprehensive primary care services, manage ... Strong understanding of medical documentation, coding (ICD-10, HCC), and risk adjustment. * Active ...
Primary Care NP/PA (Multilingual / East Asian Community Focused)
Catonsville, MD · On-site
$130K - $165K/yr
As part of a close-knit clinical team, you will provide comprehensive primary care services, manage ... Strong understanding of medical documentation, coding (ICD-10, HCC), and risk adjustment. * Active ...
Primary Care NP/PA (Multilingual / East Asian Community Focused)
Catonsville, MD · On-site
$130K - $165K/yr
As part of a close-knit clinical team, you will provide comprehensive primary care services, manage ... Strong understanding of medical documentation, coding (ICD-10, HCC), and risk adjustment. * Active ...
Primary Care NP/PA (Multilingual / East Asian Community Focused)
Catonsville, MD · On-site
$130K - $165K/yr
As part of a close-knit clinical team, you will provide comprehensive primary care services, manage ... Strong understanding of medical documentation, coding (ICD-10, HCC), and risk adjustment. * Active ...
Manager Hcc Risk Adjustment information
What is a Manager HCC Risk Adjustment?
Manager HCC Risk Adjustment jobs involve overseeing teams and processes that assess and improve Hierarchical Condition Category (HCC) coding and risk adjustment in healthcare organizations. These managers ensure accurate documentation and coding of patient diagnoses to optimize reimbursement and compliance with government regulations. They collaborate with coders, clinicians, and data analysts to monitor performance, provide training, and implement best practices. Their role is critical in maximizing risk-adjusted revenue while maintaining high standards of patient data integrity.
What are the key skills and qualifications needed to thrive as a Manager HCC Risk Adjustment?
To thrive as a Manager HCC Risk Adjustment, you need expertise in healthcare coding (especially ICD-10), risk adjustment methodologies, and a background in health administration or a related field, often supported by a relevant degree and coding certifications like CRC or CPC. Familiarity with risk adjustment analytics platforms, EHR systems, and healthcare data reporting tools is important. Strong leadership, analytical thinking, and effective communication skills enable you to guide teams and collaborate across departments. These skills and qualifications are essential to ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.
How does a Manager HCC Risk Adjustment typically collaborate with other departments to ensure accurate risk scoring?
A Manager HCC Risk Adjustment frequently partners with coding teams, clinical staff, and data analysts to ensure that documentation and coding accurately reflect patient conditions for risk adjustment purposes. This collaboration often involves leading training sessions, reviewing charts for compliance, and coordinating audits to identify documentation gaps. Working closely with these departments helps ensure data integrity, optimize risk scores, and support organizational goals related to reimbursement and quality reporting.
What is the difference between Manager Hcc Risk Adjustment vs Hcc Risk Adjustment Specialist?
| Aspect | Manager Hcc Risk Adjustment | Hcc Risk Adjustment Specialist |
|---|---|---|
| Credentials | Typically requires a bachelor’s degree, industry certifications (e.g., CPC, CCS), and experience in healthcare or risk adjustment | Often requires similar certifications and experience but may have less managerial responsibility |
| Work Environment | Supervises teams, manages projects, and collaborates with multiple departments | Focuses on data analysis, coding, and risk adjustment tasks, often working independently or in small teams |
| Employer & Industry Usage | Commonly employed by health plans, healthcare providers, and risk adjustment vendors | Found within similar organizations, often as a specialized role supporting risk adjustment processes |
The main difference is that the Manager Hcc Risk Adjustment oversees teams and manages projects, while the Hcc Risk Adjustment Specialist focuses on technical tasks like data analysis and coding. Both roles require relevant certifications and industry experience, but the manager role involves leadership responsibilities.
What are popular job titles related to Manager Hcc Risk Adjustment jobs in Maryland?
For Manager Hcc Risk Adjustment jobs in Maryland, the most frequently searched job titles are:
What job categories do people searching Manager Hcc Risk Adjustment jobs in Maryland look for?
The top searched job categories for Manager Hcc Risk Adjustment jobs in Maryland are:
What cities in Maryland are hiring for Manager Hcc Risk Adjustment jobs?
Cities in Maryland with the most Manager Hcc Risk Adjustment job openings:
Job description
*This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
Position: Nurse Subject Matter Expert (SME)
Location: Remote
About J29
J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels.
Overview
J29 is seeking a highly experienced Nurse Subject Matter Expert (SME) in support of an potential upcoming contract. The Nurse SME will serve as a senior clinical resource, providing subject matter expertise in support of program integrity initiatives, audits, investigations, data analysis, healthcare reviews, fraud, waste, and abuse (FWA) prevention efforts. This individual will collaborate with internal teams and external stakeholders to evaluate healthcare data, review medical records and claims, identify vulnerabilities, and develop recommendations that support compliance, quality, and operational effectiveness. The Nurse SME will leverage extensive clinical experience and analytical expertise to support project objectives and improve healthcare program outcomes.
Role & Responsibilities
Experience / Expertise
Preferred Qualifications
Salary: $100,000-120,000 annually based on years of experience related to the role.
J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.
Position: Nurse Subject Matter Expert (SME)
Location: Remote
About J29
J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels.
Overview
J29 is seeking a highly experienced Nurse Subject Matter Expert (SME) in support of an potential upcoming contract. The Nurse SME will serve as a senior clinical resource, providing subject matter expertise in support of program integrity initiatives, audits, investigations, data analysis, healthcare reviews, fraud, waste, and abuse (FWA) prevention efforts. This individual will collaborate with internal teams and external stakeholders to evaluate healthcare data, review medical records and claims, identify vulnerabilities, and develop recommendations that support compliance, quality, and operational effectiveness. The Nurse SME will leverage extensive clinical experience and analytical expertise to support project objectives and improve healthcare program outcomes.
Role & Responsibilities
- Provides clinical support to other functional areas (e.g., audits, complaints, data analysis, investigations, requests for information, predictive modeling, and vulnerabilities) in need of subject matter expertise.
- Works directly with the client and appropriate stakeholders, health plans, pharmacy benefit managers, other contractors, law enforcement, providers, suppliers, prescribers, and pharmacies to build partnerships, support data sharing, develop tools, and references to support program integrity initiatives.
- Initiates and contributes to the conceptual design, methodologies, and implementation of projects, as well as assist with project execution as needed.
- May provide educational programs as necessary to meet project goals, combat potential fraud, waste, and abuse, and promote high quality, safe, and effective medication use.
- Develop solutions, alternative practices, or strategies to detect and prevent FWA.
- Gather and organize information about a problem to be solved or the procedure or process to be improved.
- Analyze financial, operational, and performance data, information, and other forms of evidence.
- Participate in audit activities, such as performing audits and/or reviews of healthcare services based on billing and medical records, compendia, and criteria to evaluate the appropriateness of the patient encounters.
- Use nursing expertise to translate requirements among other professionals.
- Identify and utilize appropriate techniques in vetting data and information.
- Identify and aid in the development of best practices for conducting audits, analytics, and program vulnerability studies.
- Review and analyze encounter data, fee-for-service claims, enrollment data, prescription drug event records, and other data sources in providing advice, input, and recommendations.
Experience / Expertise
- Active, unrestricted Registered Nurse (RN) license in at least one U.S. state or territory.
- Bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related healthcare field required.
- 10+ years of clinical and healthcare industry experience, including medical record review, clinical auditing, risk adjustment, payment integrity, quality improvement, or healthcare program oversight.
- Demonstrated expertise in reviewing and interpreting medical records, claims data, encounter data, and clinical documentation.
- Strong knowledge of Hierarchical Condition Categories (HCCs), risk adjustment methodologies, risk score validation, and coding/documentation requirements.
- Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews.
- Knowledge of Health Risk Assessments (HRAs) and their role in risk adjustment and population health initiatives.
- Experience evaluating and analyzing encounter data for completeness, accuracy, and compliance.
- Working knowledge of CMS STAR Ratings, quality performance measures, and healthcare quality improvement initiatives.
- Familiarity with supplemental benefits, healthcare utilization trends, and member-focused care programs.
- Knowledge of Medical Loss Ratio (MLR) concepts and their impact on healthcare operations and performance.
- Experience identifying potential fraud, waste, abuse, compliance risks, documentation gaps, and operational vulnerabilities through clinical review and data analysis.
- Strong analytical and critical thinking skills with the ability to interpret clinical, operational, and financial data and provide actionable recommendations.
- Experience collaborating with health plans, providers, healthcare organizations, and cross-functional teams to support program objectives.
- Excellent written and verbal communication skills, including the ability to summarize clinical findings and present recommendations to stakeholders.
Preferred Qualifications
- Experience supporting healthcare program integrity, fraud, waste, and abuse (FWA) detection and prevention efforts.
- Experience conducting clinical audits, medical record reviews, claims reviews, utilization reviews, or healthcare investigations.
- Knowledge of healthcare reimbursement methodologies, claims processing, and healthcare data analytics.
- Experience working with health plans, providers, suppliers, pharmacies, or other healthcare stakeholders.
- Familiarity with healthcare compliance requirements and quality improvement methodologies.
- Experience developing educational materials, training programs, guidance documents, or best-practice recommendations.
- Professional certifications such as CPHQ, CCM, CPMA, CHC, or other relevant healthcare certifications preferred.
- Experience supporting government, commercial, or managed healthcare programs preferred.
Salary: $100,000-120,000 annually based on years of experience related to the role.
J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.
About J29
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
1 - 10 Employees
Headquarters location
Millersville, MD, US
Year founded
2017