Northbrook, IL · On-site
$75K - $165K/yr
Position Summary As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible ... Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits ...
Northbrook, IL · On-site
$75K - $165K/yr
Position Summary As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible ... Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits ...
Develop deep expertise in MedInsight's risk adjustment software and analytics, and in the surrounding market (CMS-HCC models, RADV, quality programs, value-based care, and the competitive landscape ...
Develop deep expertise in MedInsight's risk adjustment software and analytics, and in the surrounding market (CMS-HCC models, RADV, quality programs, value-based care, and the competitive landscape ...
Deep familiarity with Medicare Advantage program structure, including CMS Star Ratings, Risk Adjustment (RAF/HCC), and medical cost management strategies; knowledge of FEHBP and FEP program structure ...
Deep familiarity with Medicare Advantage program structure, including CMS Star Ratings, Risk Adjustment (RAF/HCC), and medical cost management strategies; knowledge of FEHBP and FEP program structure ...
Chicago, IL · On-site
$142 - $192/hr
Deep familiarity with Medicare Advantage program structure, including CMS Star Ratings, Risk Adjustment (RAF/HCC), and medical cost management strategies; knowledge of FEHBP and FEP program structure ...
Chicago, IL · On-site
$142 - $192/hr
Deep familiarity with Medicare Advantage program structure, including CMS Star Ratings, Risk Adjustment (RAF/HCC), and medical cost management strategies; knowledge of FEHBP and FEP program structure ...
Chicago, IL · On-site
CMS-HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician Consultation * Conduct concurrent and retrospective chart review for all assigned cases, identifying ...
Chicago, IL · On-site
CMS-HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician Consultation * Conduct concurrent and retrospective chart review for all assigned cases, identifying ...
Chicago, IL · On-site
CMS-HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician Consultation * Conduct concurrent and retrospective chart review for all assigned cases, identifying ...
Chicago, IL · On-site
CMS-HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician Consultation * Conduct concurrent and retrospective chart review for all assigned cases, identifying ...
Manages external audit execution and internal CMS Risk Adjustment Data Validation (RADV) readiness, conducting routine mock RADV audits to validate HCC chronic condition support. * Query Compliance ...
Manages external audit execution and internal CMS Risk Adjustment Data Validation (RADV) readiness, conducting routine mock RADV audits to validate HCC chronic condition support. * Query Compliance ...
Chicago, IL · On-site
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Chicago, IL · On-site
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Schererville, IN · On-site
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Schererville, IN · On-site
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Merrillville, IN · On-site
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Merrillville, IN · On-site
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Chicago, IL · On-site
$110 - $150/hr
CMS‑HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician ... HCC/RAF capture, severity tier distribution, and audit and second‑review findings. * Lead ...
New
Chicago, IL · On-site
$110 - $150/hr
CMS‑HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician ... HCC/RAF capture, severity tier distribution, and audit and second‑review findings. * Lead ...
New
Chicago, IL · On-site
$110 - $180/hr
CMS‑HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician ... HCC/RAF capture, severity tier distribution, and audit and second‑review findings. * Lead ...
Chicago, IL · On-site
$110 - $180/hr
CMS‑HCC and Risk Adjustment Factor (RAF) B. Independent Documentation Refinement After Physician ... HCC/RAF capture, severity tier distribution, and audit and second‑review findings. * Lead ...
Merrillville, IN · On-site
$112K - $140K/yr
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Merrillville, IN · On-site
$112K - $140K/yr
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Schererville, IN · On-site
$112K - $140K/yr
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Schererville, IN · On-site
$112K - $140K/yr
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Chicago, IL · On-site
$120K - $151K/yr
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Chicago, IL · On-site
$120K - $151K/yr
Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...
Chicago, IL · On-site
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
Chicago, IL · On-site
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
Chicago, IL · On-site
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
Chicago, IL · On-site
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
Chicago, IL · On-site
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
Chicago, IL · On-site
$18 - $23.25/hr
... risk from overnight events, discussing position adjustments, hedging methods, or risk reduction options * Conduct real-time firm risk surveillance during overnight hours, monitoring for concentrated ...
Chicago, IL · On-site
$65K/yr
Once licensed: independently resolve trade disputes and advise on risk exposure, margin, and position adjustments Risk Monitoring * Flag unusual account activity, potential fraud, or overnight risk ...
Chicago, IL · On-site
$65K/yr
Once licensed: independently resolve trade disputes and advise on risk exposure, margin, and position adjustments Risk Monitoring * Flag unusual account activity, potential fraud, or overnight risk ...
The most popular types of Hcc Risk Adjustment jobs in Chicago, IL are:
$75K - $165K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 13 days ago
Oversee and maintain compliance with CMS regulations related to Medicare Advantage Risk Adjustment, HCCs, encounter data submission, documentation, and coding.
Partner with various teams to ensure organizational adherence to CMS requirements and develop corrective action plans for compliance issues.
Assess operational processes for compliance risks related to risk adjustment activities and conduct compliance risk assessments.
5.8
Based on 4,361 frontline employees who took The Breakroom Quiz
92nd of 113 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
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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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
