Medical Coder CPC / CCS
$18 - $24.25/hr
... Medicare's Risk Adjustment initiatives. May require some travel to various provider partner ... Continue to audit to ensure training is implemented. Resolve and track escalated issues. Track any ...
Medical Coder CPC / CCS
$18 - $24.25/hr
... Medicare's Risk Adjustment initiatives. May require some travel to various provider partner ... Continue to audit to ensure training is implemented. Resolve and track escalated issues. Track any ...
... and Risk Adjustment. * Develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score ...
... and Risk Adjustment. * Develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score ...
The Provider Educator also performs post-visit chart validations and audits, initiates appropriate ... Medicare Advantage, value-based care, clinical documentation integrity, risk adjustment, or ...
The Provider Educator also performs post-visit chart validations and audits, initiates appropriate ... Medicare Advantage, value-based care, clinical documentation integrity, risk adjustment, or ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Community Based Quality Advanced Practice Provider
Columbus, OH · On-site
$16.75 - $22.75/hr
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Community Based Quality Advanced Practice Provider
Columbus, OH · On-site
$16.75 - $22.75/hr
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Quality Community Based Advanced Practice Provider
Cleveland, OH · On-site
$17.50 - $23.50/hr
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Quality Community Based Advanced Practice Provider
Cleveland, OH · On-site
$17.50 - $23.50/hr
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Field Nurse Practitioner / Physician Assistant - Montgomery County, Ohio
Dayton, OH · On-site
$137.76/hr
In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at risk populations. Your primary objective will be to assess the ...
Field Nurse Practitioner / Physician Assistant - Montgomery County, Ohio
Dayton, OH · On-site
$137.76/hr
In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at risk populations. Your primary objective will be to assess the ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity adapts to your ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity adapts to your ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity adapts to ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity adapts to ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waverly, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waverly, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical input into product design, Medicare bids, risk adjustment, STARS, HEDIS, value-based arrangements, and clinical integration initiatives. * Communicate complex clinical, regulatory ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical input into product design, Medicare bids, risk adjustment, STARS, HEDIS, value-based arrangements, and clinical integration initiatives. * Communicate complex clinical, regulatory ...
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 Ohio?
For Medicare Risk Adjustment Audit jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment Audit jobs in Ohio look for?
The top searched job categories for Medicare Risk Adjustment Audit jobs in Ohio are:
What cities in Ohio are hiring for Medicare Risk Adjustment Audit jobs?
Cities in Ohio with the most Medicare Risk Adjustment Audit job openings:
$18 - $24.25/hr
Full-time
Re-posted 10 days ago
Job description
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Company Job Description/Day to Day Duties:
Job Summary
Directly responsible and accountable for performing chart reviews, physician education, and development of tools to ensure that our provider partners are compliant with Risk Adjustment. Provide overall coding expertise as well as administrative and technical oversight to ensure successful integration of Molina Medicare's Risk Adjustment initiatives. May require some travel to various provider partner locations
Performs on-going chart reviews and abstracts diagnoses codes under the HCC Model.Â
Develop an understanding of current billing practices in provider offices to ensure that diagnoses codes are submitted accordingly.Â
Documents results/findings from chart reviews and provides feedback to management, providers, and office staff.Â
Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education.Â
Monitor HCC Coding Accuracy at various levels of detail (e.g., by state, by product, by demographic segmentations). Extract information necessary to identify where there are low performing physicians; follow up with plan for education and training. Continue to audit to ensure training is implemented.Â
Resolve and track escalated issues. Track any coding issues identified either at the provider level (including Molina sites) or vendor; manage any non-compliance situation or potential fraud or abuse.Â
Utilize discretion and autonomy to select provider for further training or audits; coordinate efforts with internal clients such as Coding Manager, RAMP Director, State Medicare Directors and Provider Services.Â
Determine coding quality as it relates to CMS standards; selects physicians or vendors that require an audit.Â
Qualifications
Minimum Education/Qualifications/Licensures:
Coding Certification - Active CCS, CCS-P, or CPC credentialing
Coding guidelines knowledge
Travel required (with mileage)
Claims experience
Additional Information
Employment Type: Contract 6 months. With possibility of going perm.
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003