Scottsdale, AZ · On-site
$46K - $102K/yr
Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, including risk assessment, auditing and monitoring and corrective action oversight.
Scottsdale, AZ · On-site
$46K - $102K/yr
Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, including risk assessment, auditing and monitoring and corrective action oversight.
Tempe, AZ · Hybrid
Drive and support compliance risk assessments, as well as work plan development and implementation ... Minimum of five (5) years of experience in Medicare Managed Care, with preferred expertise in ...
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Tempe, AZ · Hybrid
Drive and support compliance risk assessments, as well as work plan development and implementation ... Minimum of five (5) years of experience in Medicare Managed Care, with preferred expertise in ...
Phoenix, AZ · On-site +1
$43K - $70K/yr
The Grant Compliance Specialist performs risk assessments, plans and conducts desk reviews and on ... Arizona's Rural Health Transformation Program is supported by the Centers for Medicare & Medicaid ...
Phoenix, AZ · On-site +1
$43K - $70K/yr
The Grant Compliance Specialist performs risk assessments, plans and conducts desk reviews and on ... Arizona's Rural Health Transformation Program is supported by the Centers for Medicare & Medicaid ...
Phoenix, AZ · On-site
$43K - $70K/yr
The Grant Compliance Specialist performs risk assessments, plans and conducts desk reviews and on ... Arizona's Rural Health Transformation Program is supported by the Centers for Medicare & Medicaid ...
Phoenix, AZ · On-site
$43K - $70K/yr
The Grant Compliance Specialist performs risk assessments, plans and conducts desk reviews and on ... Arizona's Rural Health Transformation Program is supported by the Centers for Medicare & Medicaid ...
$99K - $134K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
$99K - $134K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... Medicare Advantage, and Medicaid arrangements. Operating as a peer Director within the Payor ... downside risk assessment. Performance Monitoring & Optimization: Lead post implementation ...
... Medicare Advantage, and Medicaid arrangements. Operating as a peer Director within the Payor ... downside risk assessment. Performance Monitoring & Optimization: Lead post implementation ...
... Medicare Advantage, and Medicaid arrangements. Operating as a peer Director within the Payor ... analysis, and downside risk assessment.Performance Monitoring & Optimization:Lead post ...
... Medicare Advantage, and Medicaid arrangements. Operating as a peer Director within the Payor ... analysis, and downside risk assessment.Performance Monitoring & Optimization:Lead post ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
$94K - $128K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
$94K - $128K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
$94K - $128K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
$94K - $128K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
Tucson, AZ · On-site
$106K - $135K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require a holistic view of health and a ...
Tucson, AZ · On-site
$106K - $135K/yr
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require a holistic view of health and a ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
... on Medicare, with the goal of keeping patients healthy and living life to the fullest - Administer Annual wellness visits and health risk assessments, which require aholistic view of health and ...
Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, applicable Medicaid rules and government contracts, including risk assessment ...
Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, applicable Medicaid rules and government contracts, including risk assessment ...
$21.53 is the 25th percentile. Wages below this are outliers.
$18.59 - $22.63
34% of jobs
The median wage is $25.15 / hr.
$22.63 - $26.66
25% of jobs
$26.66 - $30.69
0% of jobs
$30.69 - $34.72
0% of jobs
$34.72 - $38.75
6% of jobs
$38.75 - $42.79
2% of jobs
$42.79 - $46.82
5% of jobs
$48.16 is the 75th percentile. Wages above this are outliers.
$46.82 - $50.85
6% of jobs
$50.85 - $54.88
8% of jobs
$54.88 - $58.91
10% of jobs
$58.91 - $62.95
2% of jobs
$18
$36
$62
A Medicare Risk Assessment job involves evaluating patients' health conditions to determine risk scores that impact Medicare Advantage plan reimbursements. Professionals in this role collect and analyze medical data, review patient histories, and ensure accurate coding of diagnoses. Their work helps healthcare providers and insurers understand patient risks and deliver appropriate care. Strong knowledge of ICD-10 coding, healthcare regulations, and medical terminology is essential for this role.
One common challenge in Medicare Risk Assessment is staying up to date with frequently changing Medicare regulations and coding requirements, which directly affect risk scoring and patient documentation. Handling large volumes of patient data while ensuring accuracy and compliance can also be demanding, as errors may impact reimbursement and care outcomes. Collaboration with clinicians, billing teams, and administrators is often necessary to clarify complex cases and ensure complete, compliant documentation. Successfully navigating these challenges requires ongoing learning, keen attention to detail, and effective communication skills.
To thrive in a Medicare Risk Assessment role, you need a strong understanding of healthcare regulations, Medicare guidelines, data analysis, and clinical assessment—often supported by a background in nursing, healthcare administration, or a related field. Proficiency with health risk assessment tools, electronic health records (EHRs), and data management systems is important, and certification such as Certified Risk Adjustment Coder (CRC) can be beneficial. Attention to detail, analytical thinking, and effective communication stand out as key soft skills in this position. These skills are crucial for accurately evaluating patient risk, ensuring compliance, and supporting optimal Medicare plan outcomes.
$46K - $102K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 2 days ago
5.8
Based on 4,285 frontline employees who took The Breakroom Quiz
81st of 104 rated pharmacies
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
Position Summary
The Senior Analyst is a compliance position that applies compliance, regulatory, business, analytical and communication skills to support, manage and develop and execute Medicare compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks. The individual will work independently, as well as collaboratively, with internal senior level corporate compliance and business teams that operate Medicare Advantage in a highly complex regulatory environment and highly matrixed organization environment with a current focus on integrated special needs plans.
The analyst maintain productive relationships and open lines of communication with internal and key external stakeholders to effectively communicate and influence compliant outcomes and ensure that processes are enhanced or implemented to effectively address compliance requirements.
Responsibilities include, but are not limited to:
Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, including risk assessment, auditing and monitoring and corrective action oversight.
Develop and manage compliance strategies, programs, and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect, and mitigate compliance risks.
Track, analyze, and work open issue in a timely manner
Maintain in-depth working knowledge and expertise in Medicare regulations
Builds and maintains positive relationships at senior levels to drive decision-making and influence ethical and compliant outcomes
Monitor and audit as outlined in Medicare Compliance Work Plan and direct other projects as assigned to evaluate compliance, propose remediation where necessary and monitor implementation of corrective action
Support broader compliance initiatives and needs as assigned to ensure that effective compliance programs are achieved and maintained.
Other duties as assigned.
In order to be successful in this role you must exhibit the following: -
-Extensive knowledge of Medicare compliance programs and rules
-Experience in validation, auditing and monitoring, root cause analysis and corrective action oversight
-Outstanding time management and project management
-Proficient in utilization of information systems
-Adept at execution and delivery (planning, delivering, and supporting) skills
-Adept at collaboration and teamwork
Required Qualifications
2+ years' experience in Medicare Compliance or regulatory work
Willingness to travel up to 10% (including by plane)
Preferred Qualifications
Understand Medicare Requirements
3+ years of Medicare Compliance work
Education
Bachelor's Degree; equivalent work experience may substituate.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $102,000.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
