Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent 2-5 years of risk adjustment coding E/M procedures and diagnosis ...
Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent 2-5 years of risk adjustment coding E/M procedures and diagnosis ...
Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...
Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... Education: High School or Equivalent Experience: 2-5 years of risk adjustment coding, E/M ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... Education: High School or Equivalent Experience: 2-5 years of risk adjustment coding, E/M ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... High School Experience: 2-5 years of risk adjustment coding, E/M, procedures and diagnosis ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... High School Experience: 2-5 years of risk adjustment coding, E/M, procedures and diagnosis ...
Auditor, Risk Adjustment
Miami, FL · Remote
$82K - $108K/yr
We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...
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Auditor, Risk Adjustment
Miami, FL · Remote
$82K - $108K/yr
We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...
Risk Adjustment Data Analyst
Doral, FL · On-site
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
Risk Adjustment Data Analyst
Doral, FL · On-site
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
Risk Adjustment Data Analyst
Doral, FL · On-site
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
Risk Adjustment Data Analyst
Doral, FL · On-site
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
Medical Risk Adjustment Coder- VBC
Winter Park, FL · On-site
$17.50 - $23.50/hr
... audits for the purpose of • Identifying and validating reported diagnoses for Medicare/Medicare ... risk adjustment, and ensures accuracy, • Completeness, specificity and appropriateness of ...
Medical Risk Adjustment Coder- VBC
Winter Park, FL · On-site
$17.50 - $23.50/hr
... audits for the purpose of • Identifying and validating reported diagnoses for Medicare/Medicare ... risk adjustment, and ensures accuracy, • Completeness, specificity and appropriateness of ...
Manager Risk Adjustment Program
Tampa, FL · On-site +1
Two (2) or more years of experience in a lead risk adjustment role working with OR for Medicare Advantage health plans. *Any equivalent combination of education and experience that provides the ...
Manager Risk Adjustment Program
Tampa, FL · On-site +1
Two (2) or more years of experience in a lead risk adjustment role working with OR for Medicare Advantage health plans. *Any equivalent combination of education and experience that provides the ...
Medical Risk Adjustment Coder- VBC
Winter Park, FL · On-site
$17.50 - $23.50/hr
... audits for the purpose of • Identifying and validating reported diagnoses for Medicare/Medicare ... Certified Risk Adjustment Coder (CRC) Experience • Prior HCC/HHS experience with Medicare Risk ...
Medical Risk Adjustment Coder- VBC
Winter Park, FL · On-site
$17.50 - $23.50/hr
... audits for the purpose of • Identifying and validating reported diagnoses for Medicare/Medicare ... Certified Risk Adjustment Coder (CRC) Experience • Prior HCC/HHS experience with Medicare Risk ...
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
ACN Physician
Debary, FL · On-site
$210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
ACN Physician
Debary, FL · On-site
$210K/yr
The Ideal Candidate Should Have a Proven Track Record of Working with Medicare Advantage Patients and Be Well-Versed in HEDIS Quality Measures, Medicare Risk Adjustment (MRA), RAF Score Optimization ...
Deep understanding of Medicare Advantage, CMS regulations, HEDIS, Star Ratings, and Medicare Risk Adjustment (HCC coding). * Strong knowledge of value-based care models, ACO operations, and managed ...
Deep understanding of Medicare Advantage, CMS regulations, HEDIS, Star Ratings, and Medicare Risk Adjustment (HCC coding). * Strong knowledge of value-based care models, ACO operations, and managed ...
Nurse Practitioner
Miami, FL · On-site
Accurately document HCC (Hierarchical Condition Categories) for MRA (Medicare Risk Adjustment) * Ensure compliance with HEDIS (Healthcare Effectiveness Data and Information Set) performance measures
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Nurse Practitioner
Miami, FL · On-site
Accurately document HCC (Hierarchical Condition Categories) for MRA (Medicare Risk Adjustment) * Ensure compliance with HEDIS (Healthcare Effectiveness Data and Information Set) performance measures
Risk Adjustment Coordinator, Remote, Baptist Health Integrated Care, FT, 08A-4:30P
Boca Raton, FL · Remote
$25.37 - $32.22/hr
... Medicare beneficiaries, and others to represent the department and the health system while working ... Ability to defend coding decisions to both internal and external audits. * Strong organizational ...
Risk Adjustment Coordinator, Remote, Baptist Health Integrated Care, FT, 08A-4:30P
Boca Raton, FL · Remote
$25.37 - $32.22/hr
... Medicare beneficiaries, and others to represent the department and the health system while working ... Ability to defend coding decisions to both internal and external audits. * Strong organizational ...
Preferred Qualifications Experience in coding audits and providing actionable feedback to providers. Knowledge of healthcare reimbursement models and regulations impacting risk adjustment coding.
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Preferred Qualifications Experience in coding audits and providing actionable feedback to providers. Knowledge of healthcare reimbursement models and regulations impacting risk adjustment coding.
Certified Medical Coder - Risk Adjustment
Pompano Beach, FL · On-site
$50K - $54K/yr
Preferred Qualifications Experience in coding audits and providing actionable feedback to providers. Knowledge of healthcare reimbursement models and regulations impacting risk adjustment coding.
Certified Medical Coder - Risk Adjustment
Pompano Beach, FL · On-site
$50K - $54K/yr
Preferred Qualifications Experience in coding audits and providing actionable feedback to providers. Knowledge of healthcare reimbursement models and regulations impacting risk adjustment coding.
Medicare Risk Adjustment Audit information
What is a Medicare Risk Adjustment Audit?
A Medicare Risk Adjustment Audit is a review process conducted to ensure that healthcare providers are accurately reporting patient diagnoses to Medicare Advantage plans. This audit verifies that submitted diagnoses are supported by proper medical documentation, which affects how much Medicare pays to health plans. The goal is to prevent overpayments or underpayments and to ensure compliance with federal regulations. These audits are typically performed by the Centers for Medicare & Medicaid Services (CMS) or their contractors.
What are some common challenges faced by professionals in Medicare Risk Adjustment Audit roles, and how can they be addressed?
Professionals in Medicare Risk Adjustment Audit roles often encounter challenges such as interpreting complex medical documentation, staying updated on evolving CMS guidelines, and ensuring data accuracy for compliant risk scoring. Effective collaboration with coders, providers, and compliance teams is essential to resolve discrepancies and achieve audit objectives. Staying proactive in ongoing training and leveraging audit technologies can help address these challenges and contribute to high-quality, compliant results.
What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Auditor, and why are they important?
To thrive as a Medicare Risk Adjustment Auditor, you need expertise in medical coding, healthcare compliance, and an understanding of CMS risk adjustment guidelines, often supported by a coding certification such as CPC or CRC. Familiarity with auditing software, electronic health records (EHRs), and data analytics tools is typically required. Attention to detail, analytical thinking, and strong communication are essential soft skills for reviewing documentation and conveying findings. These skills are crucial for ensuring accurate risk adjustment coding, regulatory compliance, and optimized reimbursement for healthcare organizations.
What is the difference between Medicare Risk Adjustment Audit vs Medicare Coding Specialist?
| Aspect | Medicare Risk Adjustment Audit | Medicare Coding Specialist |
|---|---|---|
| Primary Focus | Reviewing and verifying accuracy of risk adjustment data | Assigning correct medical codes for billing and documentation |
| Certifications | Risk adjustment or auditing certifications often preferred | Medical coding certifications like CPC or CCS |
| Work Environment | Healthcare organizations, insurance companies, auditing firms | Hospitals, clinics, billing companies |
| Industry Usage | Used in Medicare Advantage plan compliance and reimbursement | Used in medical billing and claims processing |
While both roles involve healthcare data, Medicare Risk Adjustment Auditors focus on verifying the accuracy of risk scores for Medicare payments, whereas Medicare Coding Specialists assign medical codes for billing purposes. Understanding these differences helps in choosing the right career path or job focus within the healthcare industry.
What are popular job titles related to Medicare Risk Adjustment Audit jobs in Florida?
For Medicare Risk Adjustment Audit jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment Audit jobs in Florida look for?
The top searched job categories for Medicare Risk Adjustment Audit jobs in Florida are:
What cities in Florida are hiring for Medicare Risk Adjustment Audit jobs?
Cities in Florida with the most Medicare Risk Adjustment Audit job openings:
Broward Health rating
6.9
Based on 91 frontline employees who took The Breakroom Quiz
456th of 888 rated healthcare providers
Job description
Coding Specialist
Ensures procedures E&M and diagnoses are coded as documented in the medical records according to ICD-10-CM CPT-4 and HCPCS in an effort to maintain accurate coding and obtain reimbursement all within the professional coding guidelines Centers for Medicare and Medicaid (CMS) guidelines and Broward Health policies. Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness Visits Medicare Risk HRA/HCC Assessment forms Medicare Advantage plans suspect HCC condition forms prior to submission to the payer.
High School or Equivalent
2-5 years of risk adjustment coding E/M procedures and diagnosis experience required. Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC). Proficient in Microsoft Word Excel and PowerPoint. Competent in Electronic Health Records NextGen and Cerner experience preferred.
Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race color national origin gender gender identity or gender expression pregnancy sexual orientation religion age disability military status genetic information or any other characteristic protected under applicable federal or state law. At Broward Health the dedication and contributions of veterans are valued. Supporting the military community and giving back to those who served is a priority. Broward Health is proud to offer veteran's preference in the hiring process to eligible veterans and other individuals as defined by applicable law.
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About Broward Health
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A career with Broward Health means endless opportunities to grow through a wide range of experiences across the healthcare system. You will be part of a team that is continually raising the bar for patient care. Our competitive benefits package includes healthcare coverage, a matching retirement program, pension plan, and wellness programs.
Industry
Hospitals
Company size
5,001 - 10,000 Employees
Headquarters location
Fort Lauderdale, FL, US
Year founded
1938