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Medicare Risk Adjustment Chart Review Jobs in Utah

University of Utah

Endocrinology Triage Nurse

Lehi, UT · On-site

$25K/mo

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

Lehi, UT · On-site

$25K/mo

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

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 - $38.31/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 ...

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 ...

Telos

Compliance Officer

Orem, UT · On-site

$45K - $80K/yr

... and risk mitigation, and organizational readiness for regulatory inspections. DUTIES & RESPONSIBILITIES 1. Clinical Documentation and Charting Compliance * Conduct regular chart reviews to audit ...

New

Telos Residential

Compliance Officer

Orem, UT

$45K - $80K/yr

... and risk mitigation, and organizational readiness for regulatory inspections. DUTIES & RESPONSIBILITIES 1. Clinical Documentation and Charting Compliance * Conduct regular chart reviews to audit ...

New

Enzo Health

Forward Deployed Clinician

Lehi, UT · On-site

$51K - $67K/yr

OASIS review/scrubbing, ICD-10 coding, QA and chart audit, clinical documentation review, or ... Medicare/Medicaid and managed care, and Review Choice Demonstration where applicable. * Daily ...

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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

Utilization Review Nurse

University of Utah Health

Salt Lake City, UT • On-site

Full-time

Re-posted 5 days ago

University Of Utah rating

7.2

Company rating: 7.2 out of 10

Based on 159 frontline employees who took The Breakroom Quiz

385th of 621 rated colleges and universities

Job description

Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for maintaining the financial integrity of both the patient and the organization through the provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such care; achieved via managing the cost of care while providing timely and accurate information to third party payers and medical care team. This position may be required to access and administer medications within their scope of practice and according to state law.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
  • Applies approved utilization criteria to monitor appropriateness of admissions with associated levels of care and continued stay review.
  • Communication to third-party payers for initial and concurrent clinical review.
  • Reviews patient chart to ensure patient continues to meet medical necessity.
  • Documentation of all actions and information shared with care team members or third-party payer.
  • Alerts and discusses with physician/provider and case manager/discharge planner when patient no longer meets medical necessity criteria for the inpatient stay.
  • Discusses with physicians the appropriateness of resource utilization.
  • Tracks length of stay (LOS) and resource utilization to identify at risk patients.
  • Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources.
  • Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the payer per university contractual obligation.
  • Participant in UR Committee as needed.
  • Collects data on variances in LOS, avoidable days, costs/barriers to discharge/transition and denied days.
  • Prepares appeals on denied cases when appropriate.
  • At the discretion of department operational and patient care needs, this position is required to work rotating schedules, which may include variable hours, weekends, nights, and holidays to meet the staffing and patient care demands of a 24/7 complex health system. Regular, reliable, and punctual attendance during assigned shifts is considered an essential function of the role.
Knowledge / Skills / Abilities
  • Demonstrated availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient care environment.
  • Ability to perform the essential functions of the job as outlined above.
  • Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
  • Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria.
  • The ability to demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.
  • Ability to work autonomously and as a team member.

Qualifications
Required
  • One year Utilization Review or Case Management experience.
Licenses Required
  • Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under the interstate compact if switching residency to State of Utah. Must maintain current Interstate Compact (multi-state) license if residency is not being changed to Utah.
* Additional license requirements as determined by the hiring department.
Qualifications (Preferred)
Preferred
  • Basic Life Support Health Care Provider card.
  • Proficiency in application of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes.
  • Utilization Review Certification designation.
  • Knowledge of CMS Regulations.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
  • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions. This position does not provide care to patients.

Physical Requirements
Color Determination, Listening, Manual Dexterity, Sitting, Speaking, Standing, Walking

What University Of Utah employees say

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Hours and flexibility

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About University of Utah

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The University of Utah is the state’s flagship institution of higher education, with 18 schools and colleges, more than 100 undergraduate majors and graduate programs, and an enrollment of more than 38,000 students. It is a member of the Association of American Universities—an invitation-only, prestigious group of 71 leading research institutions. The U is advancing a new national model for higher education that delivers societal impact through education, research, health care, and community service, while making social, economic, and cultural contributions that improve lives across Utah and around the world.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Salt Lake City, UT, US

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