Atlanta, GA · On-site
Analyze and interpret risk adjustment data (claims, encounters, chart reviews, HCCs) to identify ... Medicare Advantage, Medicaid, or ACA). * Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 ...
Quick apply
Atlanta, GA · On-site
Analyze and interpret risk adjustment data (claims, encounters, chart reviews, HCCs) to identify ... Medicare Advantage, Medicaid, or ACA). * Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 ...
Atlanta, GA · Remote
$82K - $108K/yr
... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in ...
Quick apply
Atlanta, GA · Remote
$82K - $108K/yr
... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in ...
Atlanta, GA · On-site
$26.25 - $29.75/hr
Will report to the Manager, Medicare Risk Adjustment. As the Medical Coding Educator 2 you will ... Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will ...
Atlanta, GA · On-site
$26.25 - $29.75/hr
Will report to the Manager, Medicare Risk Adjustment. As the Medical Coding Educator 2 you will ... Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will ...
Risk Adjustment Compliance Manager Risk Adjustment Compliance Manager Location: This role requires ... site reviews, risk assessments and audit planning. * Conduct mock audits and audit training.
Risk Adjustment Compliance Manager Risk Adjustment Compliance Manager Location: This role requires ... site reviews, risk assessments and audit planning. * Conduct mock audits and audit training.
Risk Adjustment Compliance Manager Risk Adjustment Compliance Manager Location: This role requires ... site reviews, risk assessments and audit planning. * Conduct mock audits and audit training.
Risk Adjustment Compliance Manager Risk Adjustment Compliance Manager Location: This role requires ... site reviews, risk assessments and audit planning. * Conduct mock audits and audit training.
Risk Adjustment Compliance Manager Location: This role requires associates to be in-office 1 day ... site reviews, risk assessments and audit planning. * Conduct mock audits and audit training.
Risk Adjustment Compliance Manager Location: This role requires associates to be in-office 1 day ... site reviews, risk assessments and audit planning. * Conduct mock audits and audit training.
... and Risk Adjustment. * Develop and manage clinical quality reviews to ensure peer review and ... 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 ... 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 ... 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 ... 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 ... 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 ... quality chart audit process including targeting chart reviews, auditing percentages, score ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Atlanta, GA · On-site
$41.85/hr
... Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data ... Assists with Regulatory Audits by performing first coding review and ranking of charts. Build ...
Atlanta, GA · On-site
$41.85/hr
... Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data ... Assists with Regulatory Audits by performing first coding review and ranking of charts. Build ...
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
Norcross, GA · On-site
$150 - $190/hr
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
Norcross, GA · On-site
$150 - $190/hr
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
The purpose of this role is to provide strategic leadership for Medicare Advantage quality performance, risk adjustment, coding integrity and reimbursement optimization across PruittHealth Premier ...
Review and approve APP, RN, SW, and PharmD plans of care, and review, approve, and co-sign APP ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
Review and approve APP, RN, SW, and PharmD plans of care, and review, approve, and co-sign APP ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
Review and approve APP, RN, SW, and PharmD plans of care. * Review, approve, and co-sign APP ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
Review and approve APP, RN, SW, and PharmD plans of care. * Review, approve, and co-sign APP ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
Review and approve APP, RN, SW, and PharmD plans of care, and co-sign APP encounters. * Accountable ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
Review and approve APP, RN, SW, and PharmD plans of care, and co-sign APP encounters. * Accountable ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
Review and approve APP, RN, SW, and PharmD plans of care. * Overall accountability for reducing ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
Review and approve APP, RN, SW, and PharmD plans of care. * Overall accountability for reducing ... Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
... review processes. * Develop and deliver education to physicians and other clinicians on ... quality, risk adjustment, and reimbursement. * Oversee the physician query process, ensuring ...
... review processes. * Develop and deliver education to physicians and other clinicians on ... quality, risk adjustment, and reimbursement. * Oversee the physician query process, ensuring ...
| Aspect | Medicare Risk Adjustment Chart Review | Medical Coder |
|---|---|---|
| Primary Focus | Reviewing patient charts to ensure accurate risk adjustment data for Medicare | Assigning medical codes based on clinical documentation for billing and records |
| Certifications | Often requires coding certifications and knowledge of Medicare guidelines | Certified Professional Coder (CPC) or equivalent |
| Work Environment | Healthcare facilities, insurance companies, or remote | Hospitals, clinics, or billing companies |
| Industry Usage | Medicare Advantage plans, risk adjustment programs | Medical billing, coding, and documentation |
While both roles involve medical documentation, Medicare Risk Adjustment Chart Review focuses on analyzing charts to optimize Medicare risk scores, whereas Medical Coders assign codes for billing purposes. Understanding these differences helps in choosing the right career path or job focus within healthcare documentation and billing.
For Medicare Risk Adjustment Chart Review jobs in Georgia, the most frequently searched job titles are:
The top searched job categories for Medicare Risk Adjustment Chart Review jobs in Georgia are:
Cities in Georgia with the most Medicare Risk Adjustment Chart Review job openings:
Atlanta, GA • On-site
Contractor
Re-posted 11 days 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.
Sourced by ZipRecruiter
11 - 50 Employees
Charlotte, NC, US
2004
