Medical Coder CPC / CCS
$18 - $24.25/hr
... 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. Develop an ...
Medical Coder CPC / CCS
$18 - $24.25/hr
... 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. Develop an ...
... coding, and risk-adjustment opportunities for the treating clinician's review and clinical ... Chart Preparation and Documentation Review * Review available medical records before scheduled ...
... coding, and risk-adjustment opportunities for the treating clinician's review and clinical ... Chart Preparation and Documentation Review * Review available medical records before scheduled ...
... 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 ...
... 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
... risk adjustment assessments for Medicare members and other at risk populations. Your primary ... review, vital signs, review of medication history, review of current prescriptions, review of ...
Field Nurse Practitioner / Physician Assistant - Montgomery County, Ohio
Dayton, OH · On-site
$137.76/hr
... risk adjustment assessments for Medicare members and other at risk populations. Your primary ... review, vital signs, review of medication history, review of current prescriptions, review of ...
... Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
Quick apply
... Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
Quick apply
... Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
Quick apply
... HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... HRAs) for Medicare and Medicaid members in and around Winchester, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
Quick apply
... Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
Quick apply
... HRAs) for Medicare and Medicaid members in and around Springfield, OH. This unique opportunity ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
Quick apply
... Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Fairfield, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
... Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ... Review medical history and ensure accurate and timely documentation. * Conduct medical ...
PHYSICIAN ADVISOR
Dayton, OH · On-site
Participate in pre-claim mortality and risk adjustment reviews, focusing on REM score optimization and accurate capture of clinical risk variables. Support PSI/HAC reviews from a CDI perspective in ...
PHYSICIAN ADVISOR
Dayton, OH · On-site
Participate in pre-claim mortality and risk adjustment reviews, focusing on REM score optimization and accurate capture of clinical risk variables. Support PSI/HAC reviews from a CDI perspective in ...
Medicare Risk Adjustment Chart Review information
What is Medicare Risk Adjustment Chart Review?
Medicare Risk Adjustment Chart Review is a process where healthcare professionals review patient medical records to identify and validate diagnoses that impact Medicare Advantage risk scores. This ensures that Medicare Advantage plans receive accurate reimbursement based on the health status and complexity of their enrollees. The review helps to capture any conditions that may not have been coded during patient visits, improving data accuracy and compliance with CMS regulations.
What are some common challenges faced in a Medicare Risk Adjustment Chart Review role, and how can they be managed?
A common challenge in Medicare Risk Adjustment Chart Review is ensuring the accuracy and completeness of medical documentation to support proper coding and risk adjustment. Reviewers often encounter incomplete records or ambiguous provider notes, which requires strong attention to detail and effective communication with healthcare staff to clarify information. Staying current with CMS guidelines and coding updates is essential, as regulations and requirements can change frequently. Proactively collaborating with providers and participating in regular training sessions can help manage these challenges and improve review quality.
What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Chart Reviewer, and why are they important?
To thrive as a Medicare Risk Adjustment Chart Reviewer, you need a solid understanding of medical coding (CPT, ICD-10), healthcare compliance, and clinical documentation, often supported by a coding certification such as CPC, CRC, or CCS. Familiarity with electronic medical records (EMRs), risk adjustment software, and auditing tools is typically required. Attention to detail, analytical thinking, and strong communication skills set top performers apart in accurately interpreting and reporting clinical data. These competencies are crucial for ensuring accurate risk adjustment, regulatory compliance, and optimized reimbursement for healthcare organizations.
What is the difference between Medicare Risk Adjustment Chart Review vs Medical Coder?
| 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.
What are popular job titles related to Medicare Risk Adjustment Chart Review jobs in Ohio?
For Medicare Risk Adjustment Chart Review jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment Chart Review jobs in Ohio look for?
The top searched job categories for Medicare Risk Adjustment Chart Review jobs in Ohio are:
What cities in Ohio are hiring for Medicare Risk Adjustment Chart Review jobs?
Cities in Ohio with the most Medicare Risk Adjustment Chart Review job openings:
Medical Coder CPC / CCS
Columbus, OH
Healthcare Support Staffing •Â
Recruiting and Staffing Services • 201 - 500 employees201 - 500 employees
$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