Risk Adjustment Coding & Compliance Expert
Blue Shield of California
Blue Shield of California seeks a Risk Adjustment Compliance Coding Specialist (Consultant) to ensure accurate coding for ACA, Medi-Cal, and Medicare Advantage programs. You will review clinical documentation, assign ICD-10-CM codes including HCCs, and support audits to maintain regulatory compliance and proper reimbursement. The role requires a bachelor’s degree and CRC/CPC/CCS or equivalent, 6+ years in healthcare coding/compliance, proficiency with EHR systems and CMS guidelines, and #J-18808-Ljbffr Blue Shield of California
$102k - $115k
...$115,000 / year Department: Quality - Risk Adjustment Description Astrana Health is seeking... ...programs designed to ensure all diagnosed codes and conditions are properly supported... ...organizations in the areas of risk adjustment and compliance. Serve as the vendor (Chart review/AWV...RiskWork at officeRemote work$70k - $85k
Risk Adjustment Coding Specialist II - Orange County Department: Quality - Risk Adjustment Employment Type: Full Time Location: 600 City Parkway... .... Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, stay informed...RiskFull timeWork at office- The Risk Adjustment Compliance Specialist, Principal is responsible for ensuring organizational compliance with laws related to Risk Adjustment across... ..., and recommendations for improvement. Collaborate with coding, clinical, and data management teams to ensure accurate and...RiskFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
$123.09k - $184.8k
Your Role The Risk Adjustment Compliance Coding Specialist (Consultant) helps to ensure organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medi-Cal (Medicaid), and Medicare Advantage lines of business. Specifically, the role helps...RiskFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week$102k - $115k
A healthcare organization is seeking a Manager - Risk Adjustment to lead risk adjustment initiatives, ensuring accurate documentation and compliance within the healthcare framework. You will oversee operations, coordinate with medical providers, and manage incentive programs...RiskRemote job- Blue Shield of California is seeking a Risk Adjustment Compliance Specialist, Principal to ensure compliance across ACA Marketplace, Medicaid, and... ..., and improve risk adjustment processes, partnering with coding, clinical, and data teams. The role requires a strategic thinker...Risk
- ...established leader in claims management, seeks a Workers' Compensation Adjuster handling California claims (License Required). This remote role is ideal for someone with experience at a TPA and a passion for risk management. You will evaluate claims, manage end-to-end...RiskRemote job
- ...professional to support end-to-end retrospective chart review and risk adjustment analytics in Oakland, CA. The role emphasizes AI-enabled... ..., develop dashboards, and collaborate with Clinical, Compliance, and Risk Adjustment teams to ensure accuracy and audit readiness...Risk
- ...Namely is seeking a Senior Construction Consultant to join their U.S. team. This remote role requires providing independent construction risk advisory and loan monitoring services with travel expectations up to 50%. The ideal candidate will possess expertise in construction...RiskRemote workFlexible hours
$180k - $200k
...enable actionable insights across risk adjustment, clinical operations, quality, compliance, and cost management. This is a... ...SDLC), including documentation, coding standards, code reviews, source... ...community knowledge in a new way. Experts add insights directly into each...RiskFull timeWork experience placementWork at officeRemote work- ...detect, prevent, and report financial crimes within its Legal & Compliance Team. You will support the BSA/AML Program for X Corp and... ...office attendance Mon-Wed. You will lead SARs, perform EDD on high-risk users, and collaborate across risk, product, and legal teams to...RiskFull timeWork at officeRemote workWeekend work
- ...seeking a senior accountant to manage R&D accruals and financial compliance. The ideal candidate will have a Bachelor's degree and 3-5+... ...ensuring compliance with US GAAP. This role is critical for accuracy and risk management within the R&D space. #J-18808-Ljbffr TalentCraftRisk
- ...Services Private Limited is seeking a Medical Auditor on a remote contract basis to review outpatient professional fee coding for accuracy and compliance. You will audit other coders’ work, identify gaps, and provide clear feedback. The role emphasizes E/M leveling, -25...Remote jobContract work
- RELI Group in Windsor Mill, MD is seeking an experienced Medical Coder to support Risk Adjustment and Medicare Part C audits. You will code inpatient, outpatient, and physician office records according to ICD-9-CM/ICD-10-CM guidelines, while maintaining high accuracy and...RiskWork at office
$70k - $85k
Astrana Health, Inc. is looking for a Risk Adjustment Coding Specialist II to support high-volume coding efforts in Orange County. This full-time position offers opportunities to analyze data and educate providers, requiring travel up to 75% of the time. The ideal candidate...RiskFull time$104k - $124.8k
...Cornerstone Staffing Solutions is seeking a detail-driven Compliance Analyst with strong experience in healthcare risk, auditing, investigations, and regulatory... ...compliance risk assessments across clinical, billing, coding, and operational functions. Identify control gaps,...RiskFull time$39.89 - $56.13 per hour
...Medical Coder to review and evaluate medical records to assign accurate diagnosis and procedure codes, ensuring optimal reimbursement while maintaining regulatory compliance. The role requires CCS, RHIT or RHIA credentials and at least two years of inpatient and outpatient...Hourly pay- ...insurance and actuarial domain expert to work directly with a... ...active state insurance license in adjusting, underwriting, or broking,... ...pricing and reserving, enterprise risk management, claims... ...employment, payroll, benefits, and compliance, while placing employees directly...RiskFull timeContract workPart timeFreelanceLive inRelocationRelocation package
- ...inland marine, etc.). Other duties associated with claims or risk‑management department operations, as necessary. Requirements... ...from investigation through resolution. Strong technical claims adjusting skills, including liability analysis, reserve setting, litigation...RiskWork at office
$102.96k
...Overview The Risk Manager leads and supports the Risk Management... ...type incident costs. Ensures compliance of both Team Member and guest... ...such as OSHA and IHS/ food codes, state/tribal compact requirements... ...relationships with claims adjusters, outside legal counsel, and...RiskContract workWork at office- BILL is seeking an Underwriting Analyst to join our Risk team in the United States. This role focuses on building the risk infrastructure... ...quantitative credit models, and contribute to PD estimation adjustments based on the business cycle. This is a unit with high impact...RiskRemote job
$37.35 - $56.03 per hour
...Enterprise Retrospective Chart Review team oversees end to end retrospective coding operations, ensuring the accuracy, completeness, and compliance of medical record review across all risk adjusted lines of business. The team manages enterprise workflows, vendor...RiskFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week$80k - $120k
A healthcare technology company is looking for an Actuarial Analyst III. This role focuses on delivering Medicare risk adjustment estimates and conducting complex revenue analysis. The ideal candidate has a Bachelor's degree in a quantitative discipline and 5+ years of...RiskRemote job$110k - $155k
...potential opportunity and risk for people in... ...experience and fit. We will adjust the scope of the role based... ...not one that checks a compliance box. Our performance... ...to call when you need expert input. Employment risk... ...technologies. Experience with coding or data analysis tools...RiskLocal areaRemote workWork visaFlexible hours$94k - $151k
...lead rate development and filing efforts for the commercial line of business, including competitive analysis, network analysis, risk adjustment, trend, actuarial benefit value analysis, and rate adequacy review. Responsibilities Lead rate development and filing efforts...RiskFull time$80k - $120k
...work with integrity as we build a better experience for physicians and their patients.Actuarial analyst III is an expert on delivering Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. Extracts, analyzes, and...RiskLocal area$24.66 - $33.94 per hour
...Crop Claims Specialist or Claims Crop Field Adjuster CA 135906 Zurich is currently looking... ...United States Department of Agriculture's Risk Management Agency. Together with RCIS... ...disability/vets. Zurich complies with 18 U.S. Code § 1033. Location(s): AM - California...RiskHourly payFull timeTemporary workSummer workWork at officeLocal areaRemote workVisa sponsorshipFlexible hours- ...including patient access, charge capture, coding, billing, payment posting, denials,... ...project progress, performance findings, risks, and recommendations to stakeholders. Process... ...practical solutions that improve efficiency, compliance, vendor performance, and revenue outcomes...RiskContract work
- Permanent Placements LLC, a globally recognized Am Law firm, is seeking a Conflicts Analyst to join its Risk Management and New Business Intake team. This role supports sophisticated legal and business conflicts throughout the firm. The position offers a rare chance to...RiskRemote jobPermanent employment
- The California State University, Office of the Chancellor, is seeking a Risk Management Administrative Analyst to provide highly complex support to Systemwide Risk Management and CSURMA staff. The role involves handling sensitive data, coordinating the annual FTPT conference...RiskWork at office
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