Los Angeles, CA · On-site +1
Enterprise risk assessment and Board-level reporting * Medicare Advantage regulatory oversight, including RADV and encounter data integrity * Operational and IT audit leadership across finance ...
Quick apply
Los Angeles, CA · On-site +1
Enterprise risk assessment and Board-level reporting * Medicare Advantage regulatory oversight, including RADV and encounter data integrity * Operational and IT audit leadership across finance ...
Pasadena, CA · On-site
$100K - $150K/yr
V28), RxHCC methodology for Medicare Part D, and HHS-HCC annual model recalibrations, including ... Evaluate results of chart review, in-home assessment, and coding audit programs to ensure ROI and ...
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Pasadena, CA · On-site
$100K - $150K/yr
V28), RxHCC methodology for Medicare Part D, and HHS-HCC annual model recalibrations, including ... Evaluate results of chart review, in-home assessment, and coding audit programs to ensure ROI and ...
Demonstratedmastery of scoping, risk assessment, control design, testingmethodology, and PCAOB-compliant documentation across financial and IT controls * Medicare Advantage & Healthcare Regulatory ...
Demonstratedmastery of scoping, risk assessment, control design, testingmethodology, and PCAOB-compliant documentation across financial and IT controls * Medicare Advantage & Healthcare Regulatory ...
Orange, CA · On-site
Demonstrated mastery of scoping, risk assessment, control design, testing methodology, and PCAOB-compliant documentation across financial and IT controls * Medicare Advantage & Healthcare Regulatory ...
Orange, CA · On-site
Demonstrated mastery of scoping, risk assessment, control design, testing methodology, and PCAOB-compliant documentation across financial and IT controls * Medicare Advantage & Healthcare Regulatory ...
... for Medicare and Medicaid members in Merced County. This is a full-time opportunity, scheduled ... We believe that happiness should be a fundamental part of every role in risk assessment. Our ...
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... for Medicare and Medicaid members in Merced County. This is a full-time opportunity, scheduled ... We believe that happiness should be a fundamental part of every role in risk assessment. Our ...
... for Medicare and Medicaid members in Merced County. This is a full-time opportunity, scheduled ... We believe that happiness should be a fundamental part of every role in risk assessment. Our ...
... for Medicare and Medicaid members in Merced County. This is a full-time opportunity, scheduled ... We believe that happiness should be a fundamental part of every role in risk assessment. Our ...
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
Burlingame, CA · On-site
$168K - $194K/yr
Conduct Medicare Annual Wellness Visits (initial and subsequent) including a health risk assessment, medical/family/social history update, medication reconciliation, and review of functional status ...
Burlingame, CA · On-site
$168K - $194K/yr
Conduct Medicare Annual Wellness Visits (initial and subsequent) including a health risk assessment, medical/family/social history update, medication reconciliation, and review of functional status ...
Madera, CA · On-site
$80K - $101K/yr
... Medicare and Medicaid Services (CMS), California Department of Public Health (CDPH) as well as any ... and assessment of quality data 25% Claims management- Notifies the Corporate Risk Manager of all ...
Madera, CA · On-site
$80K - $101K/yr
... Medicare and Medicaid Services (CMS), California Department of Public Health (CDPH) as well as any ... and assessment of quality data 25% Claims management- Notifies the Corporate Risk Manager of all ...
Oakland, CA · On-site
$123K - $184K/yr
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
Oakland, CA · On-site
$123K - $184K/yr
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
Oakland, CA · On-site
$123.09 - $184.80/hr
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
New
Oakland, CA · On-site
$123.09 - $184.80/hr
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
New
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred * Requires deep familiarity with compliance risk assessments and audits * Requires direct experience ...
Huntington Beach, CA · On-site +1
$28.50 - $32.25/hr
... documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record ...
Huntington Beach, CA · On-site +1
$28.50 - $32.25/hr
... documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record ...
Huntington Beach, CA · On-site
$72K - $80K/yr
... documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record ...
Huntington Beach, CA · On-site
$72K - $80K/yr
... documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record ...
Huntington Beach, CA · On-site
$28.75 - $32.75/hr
... documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record ...
Huntington Beach, CA · On-site
$28.75 - $32.75/hr
... documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record ...
Strong understanding of internal control frameworks and risk assessment methodologies * Experience ... Prefer: Healthcare experience (e.g., Medi-Cal, Medicare) #J-18808-Ljbffr
New
Strong understanding of internal control frameworks and risk assessment methodologies * Experience ... Prefer: Healthcare experience (e.g., Medi-Cal, Medicare) #J-18808-Ljbffr
New
Burlingame, CA · On-site
$168K - $194K/yr
Conduct Medicare Annual Wellness Visits (initial and subsequent) including a health risk assessment, medical/family/social history update, medication reconciliation, and review of functional status ...
Burlingame, CA · On-site
$168K - $194K/yr
Conduct Medicare Annual Wellness Visits (initial and subsequent) including a health risk assessment, medical/family/social history update, medication reconciliation, and review of functional status ...
... our Medicare Advantage plan. Candidates must be licensed as a Registered Nurse or as a Social ... The health risk assessment includes a systematic and pertinent collection of data about the health ...
... our Medicare Advantage plan. Candidates must be licensed as a Registered Nurse or as a Social ... The health risk assessment includes a systematic and pertinent collection of data about the health ...
Partners with corporate risk and quality solutions and Medicare Stars leadership to develop the local Medicare Stars work plan, and execute on interventions designed to improve Consumer Assessment of ...
Partners with corporate risk and quality solutions and Medicare Stars leadership to develop the local Medicare Stars work plan, and execute on interventions designed to improve Consumer Assessment of ...
Long Beach, CA · On-site +1
$122K - $238K/yr
Oversees health plan execution for risk and quality, including alignment with enterprise quality ... Medicare Stars work plan, and execute on interventions designed to improve Consumer Assessment of ...
Long Beach, CA · On-site +1
$122K - $238K/yr
Oversees health plan execution for risk and quality, including alignment with enterprise quality ... Medicare Stars work plan, and execute on interventions designed to improve Consumer Assessment of ...
$22.80 is the 25th percentile. Wages below this are outliers.
$19.69 - $23.96
34% of jobs
The median wage is $26.63 / hr.
$23.96 - $28.23
25% of jobs
$28.23 - $32.50
0% of jobs
$32.50 - $36.77
0% of jobs
$36.77 - $41.04
6% of jobs
$41.04 - $45.31
2% of jobs
$45.31 - $49.58
5% of jobs
$51.01 is the 75th percentile. Wages above this are outliers.
$49.58 - $53.85
6% of jobs
$53.85 - $58.12
8% of jobs
$58.12 - $62.39
10% of jobs
$62.39 - $66.66
2% of jobs
$19
$38
$66
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.
Full-time
Re-posted 10 days ago
A highly regarded and well-respected national healthcare organization is seeking a transformational Vice President, Internal Audit to lead enterprise-wide audit, risk, and control strategy within a highly regulated Medicare Advantage environment.
*Remote or Hybrid Available*
*$300-$420K Total Comp (base + annual bonus) + additional annual equity*
The selected executive will serve as a strategic advisor to executive leadership and the Audit Committee, driving SOX governance, enterprise risk management, operational audit excellence, and regulatory readiness across a complex healthcare platform serving Medicare Advantage members nationwide.
Key areas of focus include:
Qualifications:
