Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models * Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs * Proven track ...
Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models * Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs * Proven track ...
Experience supporting healthcare operations, risk adjustment, coding operations, audit reporting ... CDI tracking, provider education reporting, or similar regulated activities. * Convert complex data ...
Experience supporting healthcare operations, risk adjustment, coding operations, audit reporting ... CDI tracking, provider education reporting, or similar regulated activities. * Convert complex data ...
Hierarchical Condition Category (HCC) Coding Specialist
Richmond, VA · On-site
$41.85/hr
... Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and ...
Hierarchical Condition Category (HCC) Coding Specialist
Richmond, VA · On-site
$41.85/hr
... Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and ...
Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations ...
Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations ...
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA. This unique ...
Quick apply
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA. This unique ...
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Waynesboro, VA · On-site
$104K - $135K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA.
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Waynesboro, VA · On-site
$104K - $135K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA.
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Harrisonburg, VA · On-site
$101K - $131K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA. This unique ...
Quick apply
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Harrisonburg, VA · On-site
$101K - $131K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA. This unique ...
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Harrisonburg, VA · On-site
$101K - $131K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA.
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Harrisonburg, VA · On-site
$101K - $131K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA.
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Director, Actuarial
Norfolk, VA · On-site
$120 - $150/hr
... Medicare and Medicaid lines of business. This role is critical to ensuring market-competitive ... Risk Adjustment, and Clinical teams to drive enterprise value and support SHP's growth strategy.
Director, Actuarial
Norfolk, VA · On-site
$120 - $150/hr
... Medicare and Medicaid lines of business. This role is critical to ensuring market-competitive ... Risk Adjustment, and Clinical teams to drive enterprise value and support SHP's growth strategy.
IPA Consultative Coder
Virginia Beach, VA · On-site
Required Qualifications * 3+ years of risk adjustment Medical Coding or risk adjustment Provider ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
IPA Consultative Coder
Virginia Beach, VA · On-site
Required Qualifications * 3+ years of risk adjustment Medical Coding or risk adjustment Provider ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Required Qualifications: * 3+ years of risk adjustment Medical Coding or risk adjustment Provider ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Required Qualifications: * 3+ years of risk adjustment Medical Coding or risk adjustment Provider ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
IPA Consultative Coder
Hampton, VA · On-site
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
IPA Consultative Coder
Hampton, VA · On-site
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
IPA Consultative Coder
Chesapeake, VA · On-site
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
IPA Consultative Coder
Chesapeake, VA · On-site
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Required Qualifications: * 3+ years of risk adjustment Medical Coding or risk adjustment Provider ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Required Qualifications: * 3+ years of risk adjustment Medical Coding or risk adjustment Provider ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
IPA Consultative Coder
Hampton, VA · On-site
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
IPA Consultative Coder
Hampton, VA · On-site
Use your skills to make an impact Required Qualifications: * 3+ years of risk adjustment Medical ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...
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 Virginia?
For Medicare Risk Adjustment Audit jobs in Virginia, the most frequently searched job titles are:
- Healthcare Risk Analyst
- Seasonal Optum Health Coding Risk Adjustment
- Remote Risk Analyst
- Freelance Remote Risk Adjustment Coder
- Full Time Remote Risk Adjustment Coder
- Seasonal Hcc Risk Adjustment Coding
- Hcc Risk Adjustment
- Remote Chart Review Physician
- Remote Hcc Risk Adjustment
- Senior Vendor Risk Management
What job categories do people searching Medicare Risk Adjustment Audit jobs in Virginia look for?
The top searched job categories for Medicare Risk Adjustment Audit jobs in Virginia are:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 6 days ago
Ennoble Care rating
4.2
Based on 6 frontline employees who took The Breakroom Quiz
Job description
About Us
Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, "To Care is an Honor." Join Ennoble Care today!
We are seeking an experienced Sr. Medical Economics Analyst to join our value-based care (VBC) team in our Accountable Care Organization (ACO). This role requires a seasoned professional with 3-5 years of data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes.
Key ResponsibilitiesRisk Assessment & Medicare Analytics
- Develop and maintain sophisticated risk-adjusted provider group performance models using CMS-HCC methodology.
- Analyze VBC performance under various CMS and CMMI total cost-of-care models.
- Monitor and forecast financial performance across assigned patient populations.
- Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets, including simulating CMS-HCC risk adjustment.
Data Management & Analytics
- Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
- Ensure data quality and integrity across all analytical processes.
Business Intelligence & Reporting
- Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
- Develop executive dashboards and performance metrics aligned with organizational strategic goals.
- Present findings and recommendations to leadership teams and clinical stakeholders.
- Support budget planning and financial forecasting processes.
Regulatory Compliance & Process Improvement
- Stay current with evolving CMS and CMMI program requirements and quality measures.
- Collaborate with revenue cycle and coding teams to optimize documentation and billing accuracy.
Education & Certification
- Bachelor's degree in Data Science, Statistics, Mathematics, Economics, Business Administration or related quantitative field
Experience Requirements
- 3-5 years of data analytics experience, preferably in healthcare or Medicare-focused environments
- Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models
- Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs
- Proven track record analyzing Medicare claims data, specifically CCLF and BCDA datasets
- In-depth knowledge of healthcare billing processes from both provider and CMS perspectives
Technical Proficiency
- Advanced proficiency in Microsoft Excel (pivot tables, complex formulas, VBA preferred)
- Strong SQL skills with ability to write complex queries and optimize database performance
- Experience with Microsoft Azure cloud platform and related analytics tools
- Proven ability to work with very large datasets (multi-million row files) and combine data from multiple sources
- Experience integrating EHR data with claims datasets for comprehensive population health analysis
Core Competencies
- Exceptional analytical and problem-solving capabilities
- Strong business acumen with the ability to translate technical findings into strategic recommendations
- Excellent written and verbal communication skills for both technical and non-technical audiences
- Proven team player with a collaborative approach to cross-functional projects
- Demonstrated capability to understand and respond to evolving business needs
Location: Fully Remote (with up to 10% travel)
This position requires the ability to work with sensitive healthcare information and maintain strict confidentiality in accordance with HIPAA and other applicable regulations.
Full-time employees qualify for the following benefits:
- Medical, Dental, Vision and supplementary benefits such as Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity.
- Paid Time Off
- Paid Office Holidays
All employees qualify for these benefits:
- Paid Sick Time
- 401(k) with up to 3% company match
- Referral Program
- Payactiv: pay-on-demand. Cash out earned money when and where you need it!
Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) before an offer of employment is extended.
Ennoble Care is an Equal Opportunity Employer, committed to hiring the best team possible, and does not discriminate against protected characteristics including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.
What Ennoble Care employees say
Benefits
Hours and flexibility
Workplace
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About Ennoble Care
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
201 - 500 Employees
Headquarters location
Hackensack, NJ, US