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Medicare Risk Adjustment Chart Review Jobs in Utah

Imh

Value Based Care Director - Select Health

Murray, UT · On-site

$59.50 - $91.84/hr

Familiarity with risk adjustment, Star Ratings, quality bonus payments, and CMS policy as they relate to value-based strategy in Medicare Advantage. Location: SelectHealth - Murray Work City: Murray ...

University of Utah

PS Clinical Nurse

Lehi, UT · On-site

$32.14 - $43.88/hr

Performs phone management with patients' parents, chart review, care coordination, triage, and ... Communicates adjustments in treatment plan to families. * Formulates care plans for specific ...

University of Utah

PS Clinical Nurse

Salt Lake City, UT · On-site

$32.14 - $43.88/hr

Performs phone management with patients' parents, chart review, care coordination, triage, and ... Communicates adjustments or changes in treatment plans to patient/family. * Develops and ...

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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?

AspectMedicare Risk Adjustment Chart ReviewMedical Coder
Primary FocusReviewing patient charts to ensure accurate risk adjustment data for MedicareAssigning medical codes based on clinical documentation for billing and records
CertificationsOften requires coding certifications and knowledge of Medicare guidelinesCertified Professional Coder (CPC) or equivalent
Work EnvironmentHealthcare facilities, insurance companies, or remoteHospitals, clinics, or billing companies
Industry UsageMedicare Advantage plans, risk adjustment programsMedical 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 Utah?

For Medicare Risk Adjustment Chart Review jobs in Utah, the most frequently searched job titles are:

What job categories do people searching Medicare Risk Adjustment Chart Review jobs in Utah look for?

The top searched job categories for Medicare Risk Adjustment Chart Review jobs in Utah are:

What cities in Utah are hiring for Medicare Risk Adjustment Chart Review jobs?

Cities in Utah with the most Medicare Risk Adjustment Chart Review job openings:

Medicare Risk Adjustment Chart Review jobs near you

Risk Adjustment Campaign Associate (Risk Adjustment Coordinator)

Cambia Health Solutions

Salt Lake City, UT • Hybrid

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 20 days ago

Key responsibilities

  • Monitor daily vendor performance against project schedule.

  • Support the preparation of project reports and present information to management and project teams.

  • Retrieve medical records through internal EMR access to support risk adjustment campaigns.

Cambia Health Solutions rating

8.4

Company rating: 8.4 out of 10

Based on 32 frontline employees who took The Breakroom Quiz

124th of 315 rated insurance

Job description

Risk Adjustment Campaign Associate

Hybrid role(3days/weekin office)atourPortland, Medford, Burlington, Vancouver, Renton, Boise, Lewiston, Spokane or Salt Lake Cityoffices. Candidates must reside within commutable distance of that location.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Risk Adjustment Campaign Associate is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Campaign Associate works with the Risk Adjustment operations team on on-going activities related to Medicare Advantage and Commercial risk adjustment campaigns. Working under the direction of the Manager of Campaign Execution and alongside other cross functional teams, the campaign associate is responsible for day to day operations and performance of risk adjustment campaigns. The Risk Adjustment Campaign Associate is also responsible for internal EMR medical record retrieval for all Risk Adjustment campaigns - all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

Risk Adjustment Campaign Associate would have a Bachelor's Degree in business, project management, healthcare, or related field and at least 2 years of experience in a project support role (preferably within health care), or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

Certificate or training in Project Management a plus

CPC and CRC certification a plus

Skills and Attributes:

Ability to manage small, less complex projects with minimum supervision.

Experience with Microsoft Office suite of tools.

Demonstrated analytical and problem-solving skills.

Experience in project management methods and techniques.

Ability to interpret service provider contracts and statements of work (SOW).

Knowledge of Facets, PIMS, and claims processes is preferred.

Ability to track and monitor service provider performance and delivery quality against service level agreements (SLAs).

Ability to communicate effectively, verbally and in writing, with all levels of leadership.

Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

Monitors daily vendor performance against project schedule.

Supports the preparation of project reports and presentation of information to management, project teams, and client/customer groups.

Monitors project documentation for compliance with standards.

Develops and maintains the overall project documentation library ensuring that all documentation is established, maintained and retained as necessary in project databases.

Applies continuous quality improvement techniques and methodologies to all facets of job responsibility.

May plan and manage small, well-defined projects or sub-projects under the general direction of more senior project managers.

May retrieve medical records for MA and ACA campaigns through internal EMR access based on production goals set by the manager of Risk Adjustment Campaigns.

Work Environment

Work is primarily performed in an office or remote work environment.

Travel may be required, either locally or out of state.

Oregon, Washington, Utah, and Idaho:The expected hiring range is$62,900.00 - $85,100.00, the full salary range is$59,000.00 - $97,000.00and the bonus target is5%.

About Cambia


Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.


Why Join the Cambia Team?


At Cambia, you can:

  • Work alongside diverse teams building cutting-edge solutions to transform health care.
  • Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
  • Grow your career with a company committed to helping you succeed.
  • Give back to your community by participating in Cambia-supported outreach programs.
  • Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.


In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:


  • Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
  • Annual employer contribution to a health savings account.
  • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
  • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
  • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
  • Award-winning wellness programs that reward you for participation.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.

Learn more about our benefits.


We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.


As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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