Orange, TX · Remote
$45K - $80K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
Orange, TX · Remote
$45K - $80K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
Groves, TX · Remote
$45K - $80K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
Groves, TX · Remote
$45K - $80K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
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 ...
Beaumont, TX · Remote
$35K - $41K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
Beaumont, TX · Remote
$35K - $41K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
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 ...
China Grove, TX · Remote
$45K - $80K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
China Grove, TX · Remote
$45K - $80K/yr
Drives value-based care strategies through risk adjustment and quality improvement activities ... Preferred Qualifications Experience improving quality performance for Medicaid, Medicare, and/or ...
... Medicare Shared Savings Program (MSSP) Accountable Care Organization and other Value-based Care ... Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred.
... Medicare Shared Savings Program (MSSP) Accountable Care Organization and other Value-based Care ... Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred.
... Medicare Shared Savings Program (MSSP) Accountable Care Organization and other Value-based Care ... Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred.
... Medicare Shared Savings Program (MSSP) Accountable Care Organization and other Value-based Care ... Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred.
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Jasper, TX. This unique opportunity adapts ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Jasper, TX. This unique opportunity adapts ...
Austin, TX · 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 ...
Austin, TX · 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 ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, TX. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, TX. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Canton, TX. This unique opportunity adapts ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Canton, TX. This unique opportunity adapts ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Huntsville, TX. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Huntsville, TX. This unique opportunity ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Livingston, TX. This unique opportunity adapts to your ...
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Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Livingston, TX. This unique opportunity adapts to your ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Jasper, TX. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Jasper, TX. This unique opportunity adapts to your ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Livingston, TX. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Livingston, TX. This unique opportunity ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Canton, TX. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Canton, TX. This unique opportunity adapts to your ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cisco, TX. This unique opportunity adapts to your ...
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Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cisco, TX. This unique opportunity adapts to your ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Huntsville, TX. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Huntsville, TX. This unique opportunity adapts to your ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, TX. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Fairfield, TX. This unique opportunity adapts to your ...
$11.87 - $14.19
16% of jobs
$14.79 is the 25th percentile. Wages below this are outliers.
$14.19 - $16.51
34% of jobs
$16.51 - $18.83
18% of jobs
$18.83 - $21.15
1% of jobs
$22.38 is the 75th percentile. Wages above this are outliers.
$21.15 - $23.47
10% of jobs
$23.47 - $25.80
4% of jobs
$25.80 - $28.12
3% of jobs
$28.12 - $30.44
2% of jobs
$30.44 - $32.76
9% of jobs
$32.76 - $35.08
0% of jobs
$35.08 - $37.40
2% of jobs
$11
$20
$37
Jobs in Medicare risk adjustment include work in data analytics, consulting, insurance, and closely related industries. Your duties and responsibilities differ depending on the type of work. For example, as a Medicare risk-adjustment consultant, you provide advice and recommendations to healthcare organizations or an insurance provider on how to mitigate risk across a customer pool. Data analytics and statistics specialists gather and analyze insurance and Medicare data and documentation from hospitals, healthcare providers, and other medical care facilities that accept Medicare. This includes reviewing different types of diagnosis and comparing patient chart information. Some health care providers have in-house risk adjustment workers, while others contract with outside consulting and analytics firms.
| Aspect | Medicare Risk Adjustment | Medicare Coding Specialist |
|---|---|---|
| Primary Focus | Assessing patient health risk scores for reimbursement | Accurately coding medical diagnoses and procedures |
| Required Credentials | Certifications in risk adjustment or coding, often CPC or RHIT | Certifications like CPC, CCS, or RHIT |
| Work Environment | Health plans, risk adjustment companies, healthcare providers | Hospitals, clinics, billing departments |
| Industry Usage | Used for Medicare Advantage plan reimbursements | Used for medical billing and claims processing |
While both roles involve healthcare coding and require similar certifications, Medicare Risk Adjustment focuses on evaluating patient health data to determine reimbursement levels, whereas Medicare Coding Specialists concentrate on accurately coding diagnoses and procedures for billing purposes.
$45K - $80K/yr
Full-time
Re-posted 2 days ago
8.0
Based on 198 frontline employees who took The Breakroom Quiz
163rd of 304 rated insurance
Provides support for health plan provider engagement activities. Drives value-based care strategies through risk adjustment and quality improvement activities. Ensures smaller, less advanced tier II and tier III providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives.
Essential Job Duties
Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
Ensures assigned tier II and tier III providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.
Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness.
Works collaboratively with health plan and shared service partners to ensure alignment to business goals.
Accountable for use of standard Molina Provider Engagement reports and training materials.
Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies.
Communicates effectively with internal and external stakeholders, including providers, practice managers, and medical assistants within assigned provider practices.
Maintains the highest level of compliance.
May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.
Required Qualifications
At least 2 years of experience improving provider quality performance through provider engagement, practice transformation, and/or managed care quality improvement initiatives, or equivalent combination of relevant education and experience.
Experience with various managed health care provider compensation methodologies including but not limited to: fee-for service (FFS), value-based care (VBC), and capitation.
Working knowledge of quality metrics and risk adjustment practices across all business lines.
Knowledge and understanding of HEDIS/NCQA.
Proficiency with data analysis, manipulation, interpretation and reporting.
Critical-thinking, problem-solving and analytical skills.
Relationship building skills.
Attention to detail and organizational skills.
Ability to implement process improvement initiatives and drive change.
Ability to work independently in a fast-paced, deadline-driven environment.
Ability to work in a cross-functional highly matrixed organization.
Effective verbal and written communication skills.
Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.
Preferred Qualifications
Experience improving quality performance for Medicaid, Medicare, and/or Marketplace programs.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $45,390 - $80,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
