Manager, Risk Adjustment
Worcester, MA · On-site
$90K/yr
... Risk Adjustment activities. This position is responsible for the strategy, execution and ... HCC model (including V24 -V28 transition management). * Evaluate current vendor performance ...
Manager, Risk Adjustment
Worcester, MA · On-site
$90K/yr
... Risk Adjustment activities. This position is responsible for the strategy, execution and ... HCC model (including V24 -V28 transition management). * Evaluate current vendor performance ...
Manager, Risk Adjustment
Worcester, MA · On-site
... Risk Adjustment activities. This position is responsible for the strategy, execution and ... HCC model (including V24 -V28 transition management). * Evaluate current vendor performance ...
Manager, Risk Adjustment
Worcester, MA · On-site
... Risk Adjustment activities. This position is responsible for the strategy, execution and ... HCC model (including V24 -V28 transition management). * Evaluate current vendor performance ...
Risk Adjustment Coder
Denver, CO · Remote
$27.88 - $32.21/hr
HCC (Hierarchical Condition Category) Coding, medical coding, clinical terminology and anatomy ... Supports all Strive risk adjustment projects to comply with all CMS requirements by analyzing ...
Risk Adjustment Coder
Denver, CO · Remote
$27.88 - $32.21/hr
HCC (Hierarchical Condition Category) Coding, medical coding, clinical terminology and anatomy ... Supports all Strive risk adjustment projects to comply with all CMS requirements by analyzing ...
Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, conduct training with individual and large provider groups, predominantly virtually * Educate providers on the purpose ...
Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, conduct training with individual and large provider groups, predominantly virtually * Educate providers on the purpose ...
Risk Adjustment Validation Audits (RADV), conduct chart review of inpatient and outpatient medical records for Hierarchal Condition Category (HCC) coding. * Review results of risk adjustment audits ...
Risk Adjustment Validation Audits (RADV), conduct chart review of inpatient and outpatient medical records for Hierarchal Condition Category (HCC) coding. * Review results of risk adjustment audits ...
Risk Adjustment Coder
Denver, CO · On-site +1
$19.25 - $25.75/hr
HCC (Hierarchical Condition Category) Coding, medical coding, clinical terminology and anatomy ... Supports all Strive risk adjustment projects to comply with all CMS requirements by analyzing ...
Risk Adjustment Coder
Denver, CO · On-site +1
$19.25 - $25.75/hr
HCC (Hierarchical Condition Category) Coding, medical coding, clinical terminology and anatomy ... Supports all Strive risk adjustment projects to comply with all CMS requirements by analyzing ...
Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, conduct training with individual and large provider groups, predominantly virtually * Educate providers on the purpose ...
Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, conduct training with individual and large provider groups, predominantly virtually * Educate providers on the purpose ...
Risk Adjustment Program Manager
Manhattan, NY · On-site
$125K - $145K/yr
As a Risk Adjustment Program Manager, you will develop strategies to ensure risk adjustment data ... HHS-HCC (Qualified Health Plans), 3M CRG (New York State Medicaid), CMS-HCC (Medicare)
Risk Adjustment Program Manager
Manhattan, NY · On-site
$125K - $145K/yr
As a Risk Adjustment Program Manager, you will develop strategies to ensure risk adjustment data ... HHS-HCC (Qualified Health Plans), 3M CRG (New York State Medicaid), CMS-HCC (Medicare)
Apply your expertise in ICD-10-CM, CPT, and HCC risk adjustment coding to ensure proper classification of diagnoses * Analyze documentation such as discharge summaries, H&Ps, progress notes, consults ...
Apply your expertise in ICD-10-CM, CPT, and HCC risk adjustment coding to ensure proper classification of diagnoses * Analyze documentation such as discharge summaries, H&Ps, progress notes, consults ...
Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)
Los Angeles, CA · On-site
$208K/yr
Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28 * Three or more years of experience in providing education to clinical and non-clinical staff * Understanding of ...
Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)
Los Angeles, CA · On-site
$208K/yr
Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28 * Three or more years of experience in providing education to clinical and non-clinical staff * Understanding of ...
HCC Coder
Lecanto, FL · On-site
$13.75 - $18.50/hr
The Role We are seeking a proactive and compassionate HCC Coder to join our Primary Care team ... This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance ...
HCC Coder
Lecanto, FL · On-site
$13.75 - $18.50/hr
The Role We are seeking a proactive and compassionate HCC Coder to join our Primary Care team ... This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance ...
Risk Adjustment Coding Manager
$38.55 - $59.49/hr
The Manager of Risk Adjustment Coding is responsible for the oversight of the HCC Coding Analyst team. The manager plays a critical role in development and execution of coding policies and compliance ...
Risk Adjustment Coding Manager
$38.55 - $59.49/hr
The Manager of Risk Adjustment Coding is responsible for the oversight of the HCC Coding Analyst team. The manager plays a critical role in development and execution of coding policies and compliance ...
HCC Coder
Lecanto, FL · On-site
$13.75 - $18.50/hr
The Role We are seeking a proactive and compassionate HCC Coder to join our Primary Care team ... This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance ...
HCC Coder
Lecanto, FL · On-site
$13.75 - $18.50/hr
The Role We are seeking a proactive and compassionate HCC Coder to join our Primary Care team ... This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance ...
Risk Adjustment Coding Manager
Broomfield, CO · On-site +1
$38.55 - $59.49/hr
The Manager of Risk Adjustment Coding is responsible for the oversight of the HCC Coding Analyst team. The manager plays a critical role in development and execution of coding policies and compliance ...
Risk Adjustment Coding Manager
Broomfield, CO · On-site +1
$38.55 - $59.49/hr
The Manager of Risk Adjustment Coding is responsible for the oversight of the HCC Coding Analyst team. The manager plays a critical role in development and execution of coding policies and compliance ...
Expert level knowledge of CMS-HCC models V24 and V28, claims data lifecycle, submission systems, regulation, compliance, and audits related to risk adjustment * Strong understanding of healthcare ...
Quick apply
Apply Early
Expert level knowledge of CMS-HCC models V24 and V28, claims data lifecycle, submission systems, regulation, compliance, and audits related to risk adjustment * Strong understanding of healthcare ...
Apply Early
Risk adjustment HCC coding experience is preferred * One year of experience to include coding ... 80 Non-exempt Grade 13 Blue Cross and Blue Shield of Kansas offers excellent competitive ...
Risk adjustment HCC coding experience is preferred * One year of experience to include coding ... 80 Non-exempt Grade 13 Blue Cross and Blue Shield of Kansas offers excellent competitive ...
This role provides strategic and operational leadership for teams responsible for auditing HCC capture, clinical validation, and documentation compliance across the full risk adjustment lifecycle.
This role provides strategic and operational leadership for teams responsible for auditing HCC capture, clinical validation, and documentation compliance across the full risk adjustment lifecycle.
Sr. Risk Adjustment Auditor
$82K - $101K/yr
Identify coding inaccuracies, unsupported diagnoses, missed HCC opportunities, and documentation ... Effective communication and collaboration skills across clinical and non-clinical stakeholders
Sr. Risk Adjustment Auditor
$82K - $101K/yr
Identify coding inaccuracies, unsupported diagnoses, missed HCC opportunities, and documentation ... Effective communication and collaboration skills across clinical and non-clinical stakeholders
ACO Risk Coding Specialist (Hybrid)
Bronx, NY · On-site
$27/hr
They will become experts in HCC-based risk adjustment (prior experience preferred, but not ... and non-clinical staff - Team-based orientation with ability to manage and report out KPIs ...
ACO Risk Coding Specialist (Hybrid)
Bronx, NY · On-site
$27/hr
They will become experts in HCC-based risk adjustment (prior experience preferred, but not ... and non-clinical staff - Team-based orientation with ability to manage and report out KPIs ...
Risk Adjustment Compliance Coding Specialist, Consultant
Oakland, CA · On-site
$111K - $167K/yr
Assign ICD-10-CM codes, including Hierarchical Condition Categories (HCC), based on thorough review ... Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding ...
Risk Adjustment Compliance Coding Specialist, Consultant
Oakland, CA · On-site
$111K - $167K/yr
Assign ICD-10-CM codes, including Hierarchical Condition Categories (HCC), based on thorough review ... Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding ...
Non Union Hcc Risk Adjustment information
How much do HCC coders make in the US?
HCC coders, specializing in Hierarchical Condition Category coding, typically earn between $50,000 and $80,000 annually in the US, depending on experience, certification, and location. Experienced coders with certifications like CPC or CCS may earn higher salaries, especially in healthcare hubs or with remote work options.
Are medical coders still in demand?
Medical coders, including those specializing in HCC risk adjustment, are in steady demand due to the ongoing need for accurate medical billing and coding in healthcare. The role often requires certification and familiarity with coding systems like ICD-10, and job opportunities are expected to grow as healthcare organizations prioritize compliance and reimbursement accuracy.
What is the difference between Non Union Hcc Risk Adjustment vs Non Union Medical Coder?
| Aspect | Non Union Hcc Risk Adjustment | Non Union Medical Coder |
|---|---|---|
| Credentials | Certifications in risk adjustment, coding, or healthcare analytics | Medical coding certifications (CPC, CCS, etc.) |
| Work Environment | Insurance companies, healthcare analytics firms, or risk adjustment departments | Hospitals, clinics, or medical billing companies |
| Industry Usage | Focuses on risk scoring for insurance reimbursement and healthcare planning | Focuses on translating medical records into codes for billing and documentation |
Non Union Hcc Risk Adjustment specialists primarily analyze health data to optimize risk scores for insurance purposes, while Non Union Medical Coders focus on accurately coding medical records for billing. Both roles require healthcare certifications but differ in their core functions and work settings.
What does HCC mean in risk adjustment?
In risk adjustment roles like Non Union Hcc Risk Adjustment, HCC stands for Hierarchical Condition Categories, which are used to model healthcare costs based on patient diagnoses. Accurate coding of HCCs helps insurers predict healthcare expenses and set appropriate premiums, making knowledge of HCCs essential for risk adjustment specialists.
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$90K/yr
Full-time
Posted 16 days ago
Job description
Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients' needs in mind.
We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.
Essential Duties and Responsibilities:
Program Strategy & Execution
RADV, Audit & Compliance
Analytics, Finance & Bid Support
Program & Team Leadership
* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Requirements
Salary Description
Starting at $90K
We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.
Essential Duties and Responsibilities:
Program Strategy & Execution
- Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
- Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
- Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
- Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
- Develop provider-level performance reporting that is transparent, defensible, and actionable.
RADV, Audit & Compliance
- Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
- Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike.
- Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.
Analytics, Finance & Bid Support
- Build and maintain the RA analytics layer - dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
- Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
- Communicate results to executive and board audiences through clear reports, dashboards, and presentations.
Program & Team Leadership
- Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
- Other duties may be assigned as needed.
* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Requirements
- Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
- Registered Nurse (RN) desired.
- CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
- 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
- Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
- Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
- Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
- Strong Microsoft Office skills (Word, Outlook, Excel and PP).
Salary Description
Starting at $90K