Nursing - Strong understanding of clinical documentation and medical record review * Certified Risk Adjustment Coder (CRC) with compliance experience * Provider coding audit/compliance leadership ...
Nursing - Strong understanding of clinical documentation and medical record review * Certified Risk Adjustment Coder (CRC) with compliance experience * Provider coding audit/compliance leadership ...
Risk Adjustment Coder (On-site)
San Antonio, TX · On-site
$17 - $22.75/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Risk Adjustment Coder (On-site)
San Antonio, TX · On-site
$17 - $22.75/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Risk Adjustment Coder (On-site)
$19.50 - $26/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Risk Adjustment Coder (On-site)
$19.50 - $26/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Risk Adjustment Coder (On-site)
San Antonio, TX · On-site
$19.50 - $26/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Risk Adjustment Coder (On-site)
San Antonio, TX · On-site
$19.50 - $26/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Risk Adjustment Coder (On-site)
San Antonio, TX · On-site
$19.50 - $26/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Risk Adjustment Coder (On-site)
San Antonio, TX · On-site
$19.50 - $26/hr
Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ...
Value Based Coder II
$25.30 - $35.74/hr
Job Requirements 2+ years of experience in outpatient coding 2+ years focused on risk adjustment ... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ...
Value Based Coder II
$25.30 - $35.74/hr
Job Requirements 2+ years of experience in outpatient coding 2+ years focused on risk adjustment ... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ...
Value Based Coder II
Houston, TX · On-site
$18 - $23.75/hr
... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ...
Value Based Coder II
Houston, TX · On-site
$18 - $23.75/hr
... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ...
Value Based Coder II
Houston, TX · On-site
$25.30 - $35.74/hr
... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ...
Value Based Coder II
Houston, TX · On-site
$25.30 - $35.74/hr
... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ...
Value Based Coder II
$25.30 - $35.74/hr
... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ...
Value Based Coder II
$25.30 - $35.74/hr
... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ...
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 ...
Value Based Coder II
Houston, TX · On-site +1
$25.30 - $35.74/hr
... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ...
Value Based Coder II
Houston, TX · On-site +1
$25.30 - $35.74/hr
... Nursing Excellence by the American Nurses Credentialing Center, receiving the award five ... as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC ...
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 Jasper, 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 Jasper, 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 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 ...
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 ...
Analyze, interpret, and present provider performance reports including HEDIS, risk adjustment, pay ... Bachelor's degree in Healthcare, Nursing, Public Health, Health Administration, Business, or a ...
Analyze, interpret, and present provider performance reports including HEDIS, risk adjustment, pay ... Bachelor's degree in Healthcare, Nursing, Public Health, Health Administration, Business, or a ...
Field Nurse Practitioner - Harris County, Texas
Houston, TX · On-site
$100/hr
Advantmed is seeking a licensed, dependable Nurse Practitioner to conduct structured, in-home wellness and risk-adjustment assessments for diverse patient populations with varying healthcare needs.
Field Nurse Practitioner - Harris County, Texas
Houston, TX · On-site
$100/hr
Advantmed is seeking a licensed, dependable Nurse Practitioner to conduct structured, in-home wellness and risk-adjustment assessments for diverse patient populations with varying healthcare needs.
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 ...
Quick apply
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 ...
Nurse Risk Adjustment information
How does a nurse risk adjustment professional typically collaborate with coding and provider teams to ensure accurate risk scoring?
Nurse Risk Adjustment professionals often work closely with medical coders and healthcare providers to review patient documentation and ensure diagnoses are captured accurately for risk adjustment purposes. They may participate in interdisciplinary meetings, provide education to providers on documentation best practices, and clarify coding queries. This collaborative approach helps optimize the accuracy of risk scores, which impacts reimbursement and quality metrics. Effective communication and teamwork are essential in this role to support compliance and achieve organizational goals.
What is a nurse risk adjustment?
Nurse risk adjustment nurses are specialized healthcare professionals who review patient medical records to ensure accurate documentation of diagnoses and health conditions. Their work supports the risk adjustment process, which helps health plans and providers receive appropriate compensation based on the health status of their patient populations. These nurses use their clinical expertise to identify missing or undocumented conditions, collaborate with providers to improve documentation accuracy, and help ensure compliance with federal guidelines. By doing so, they play a key role in improving patient care quality and the financial health of healthcare organizations.
What is the difference between Nurse Risk Adjustment vs Nurse Case Manager?
| Aspect | Nurse Risk Adjustment | Nurse Case Manager |
|---|---|---|
| Certifications | RN license, risk adjustment training | RN license, case management certification |
| Work Environment | Insurance companies, healthcare analytics | Hospitals, clinics, patient homes |
| Employer & Industry | Health plans, insurance providers | Healthcare providers, hospitals |
While both roles require RN licensure, Nurse Risk Adjustment focuses on analyzing and coding patient data for insurance risk models, whereas Nurse Case Managers coordinate patient care and manage treatment plans. Understanding these differences helps professionals choose the right career path within healthcare and insurance industries.
What are the key skills and qualifications needed to thrive as a nurse risk adjustment?
To thrive as a Nurse Risk Adjustment, you need a solid background in clinical nursing, comprehensive knowledge of medical coding (especially ICD-10), and familiarity with risk adjustment methodologies, typically supported by RN licensure and experience in case management or chart review. Proficiency with electronic health record (EHR) systems, coding software, and sometimes a Certified Risk Adjustment Coder (CRC) credential is valuable. Attention to detail, analytical thinking, and strong communication skills help nurses accurately review documentation and collaborate with providers. These skills ensure accurate coding and risk stratification, which directly impact healthcare reimbursement and quality reporting.
What are popular job titles related to Nurse Risk Adjustment jobs in Texas?
For Nurse Risk Adjustment jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Nurse Risk Adjustment jobs in Texas look for?
The top searched job categories for Nurse Risk Adjustment jobs in Texas are:
What cities in Texas are hiring for Nurse Risk Adjustment jobs?
Cities in Texas with the most Nurse Risk Adjustment job openings:
$75K - $165K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 22 days ago
CVS Health rating
5.8
Based on 4,333 frontline employees who took The Breakroom Quiz
89th of 112 rated pharmacies
Job description
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
As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.
The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.
Key Responsibilities
Lead the Medicare Advantage Risk Adjustment compliance program.
Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.
Assess operational processes for compliance risks related to risk adjustment activities.
Develop and implement corrective action plans for identified compliance issues.
Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.
Required Qualifications
Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance
Minimum 5 years in a leadership role
One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)
Willingness to travel up to 10% (including by plane)
Preferred Qualifications
Health Information Management (RHIA/RHIT)
Nursing - Strong understanding of clinical documentation and medical record review
Certified Risk Adjustment Coder (CRC) with compliance experience
Provider coding audit/compliance leadership experience
Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits
Education
Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
This 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. This position also includes an award target in the company's equity award program.
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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About CVS Health
Sourced by ZipRecruiter
Industry
Health care and social assistance and retail
Company size
10,000+ Employees
Headquarters location
Woonsocket, RI, US