Strategic Risk Adjustment & Quality Leader (HEDIS/Coding)
Jobtailor
Jobtailor is seeking a senior leader to oversee Risk Adjustment Coding and Quality/HEDIS programs in the U.S. The role requires expertise in risk adjustment, HEDIS, and healthcare management, with a strong track record in leading teams and implementing process improvements. The position emphasizes compliance with coding guidelines and strategic management to drive improvements in healthcare operations. A managerial background and relevant certifications are essential for success in this role. #J-18808-Ljbffr Jobtailor
$143.62k - $229.79k
...Description As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in... ...timeliness, compliance, and quality of work Provide proactive and strategic thought leadership of ways to... ...Strong understanding of diagnosis coding (ICD-10-CM) , provider documentation...QualityRisk$600 - $720 per day
...comprehensive health assessments via telehealth Document risk adjustment (HCC coding) during patient visits Close HEDIS care gaps during visits Review medical history... ...Maintain accurate visit documentation for quality programs Must-Haves ~ Active Wisconsin Nurse...HEDISQualityRiskDaily paidFor contractorsRemote workWork from homeFlexible hoursWeekday work- ...authorizations or referrals, correcting coding, calling the payer or clinic... ...requirements, financial risk, as well as other factors... ...ability to build strategic business relationships with... ...expectations for production, quality, and adjustment accuracy REQUIRED QUALIFICATIONS...QualityRiskWork at officeRemote work
- ...dramatically, this team is essential for mitigating risk and upholding regulatory compliance, directly... ...and analysts across regions, ensuring investigative quality, consistency, and throughput at scale Own the strategic direction of Stripe's global sanctions program, screening...QualityRiskShift work
$100k
...containment techniques including strategic vendor partnerships to... ...documented and claims coding is correct. Refers... ...the organization's quality program(s).... ...is the world's leading risk and claims administration... ...claims administration, loss adjusting, benefits administration...QualityRiskFull timeLocal areaFlexible hours- ..., not volume—meaning we prioritize quality over quantity, spend more time with... ...Nurse Practitioners will manage high-risk patients in a telemedicine capacity... ...reconciliation Perform HCC coding, verification, and risk adjustment Coordinate continuity of care, prevention...QualityRiskFull timeTemporary workPart timeRemote workFlexible hours
$147.75k - $236k
...regulatory requirement into a strategic business management... ...company, Meiji Yasuda to integrate risk and value insights into business... ...of timely, accurate, and high-quality analysis and reporting.... ...regulatory capital frameworks, risk‑adjusted performance measurement,...QualityRiskLocal area$106k - $146k
...infrastructure projects. As a Lead Project Manager, you'll provide strategic leadership for complex construction programs that... ...What you will doConducts project stage gate and periodic quality reviews for high risk, costly, value-added, or large, complex projects.Supports...QualityRiskFull timeContract work$111k - $189k
...Lead Strategic Partnership Data AnalystThe Lead Strategic Partnership Data Analyst turns... ...model where there is business value in adjusting the models.You will ensure analysis and... ...trends.You will analyze and address data quality issues, tests and analyzes impact of system...QualityFull timeWork at officeLocal areaRelocation packageFlexible hours- ...primary function of driving a strategic vision and leading a team of... ...operational leadership, technology leaders from throughout the... ...operational efficiency, project quality, user engagement, and business... ..., while effectively managing risk. Coordinate with project teams...QualityRisk
$115k - $135k
...serves as both a technical leader and people leader,... ...service providers and strategic security partners. Identity... ...Conduct identity risk assessments and develop... ...perception, and the ability to adjust focus. OTHER... ...a consistent focus on quality, accountability, and continuous...QualityRisk- ...executive leadership for technical quality, project delivery excellence,... ...market sector, and technical leaders to advance technical... ...Through leadership of quality, risk management, and delivery improvement... ...problem-solving efforts for strategic initiatives, key pursuits,...QualityRisk
- ...accurately, efficiently, and with a strong commitment to quality.Essential Responsibilities of the Private Wealth... ...identify opportunities to improve processes, reduce risk, and enhance efficiency.Partner on Strategic InitiativesCollaborate closely with the Director of Trust...QualityRisk3 days per week
- ...engineering oversight, code quality, release governance, process improvement, risk mitigation, budget management... ...constantly review and adjust team structure to... ...~ Ability to provide strategic recommendations that influence... ...(PRI) is the world leader in facilitating collaborative...QualityRiskWork at officeLocal area
$99.3k - $198.7k
...Abbott is a global healthcare leader that helps people live more... ...OpportunityThe Logistics & Distribution Quality Leader will lead and direct... ..., investigations, and risk assessments.Support ERP... ...predictive metrics to inform adjustments / decisions.Design and implement...QualityRiskFull timePart timeLocal areaWork visaNight shift- ...goals established for the department, and monitor all established quality assurance standards. Assist in directing and supervising all... ...management of customer or employee accidents. Report all safety risks or issues, and illegal activity, including: robbery, theft or...QualityRiskSeasonal workLocal area
- A Farm Family Territory Leader is responsible for driving profitable P&C growth in a designated... ...involves engaging in sales, service, and risk management activities to achieve... ...agency par anning:Develops and implements strategic, data-driven business plans to achieve production...RiskWork at office
- ...appropriate action. + Performs quality review on claims in compliance... .... + Ensures claims files are coded correctly and adequate documentation... ...is the world's leading risk and claims administration partner... ...claims administration, loss adjusting, benefits administration, and...QualityRiskContract workWork at officeLocal area
- ...Forvis Mazars pursue and win strategic opportunities. Working closely... ..., sector and industry leaders, and the National Proposal Team... ...review resources to improve quality, consistency, speed, and scalability... ...maintaining appropriate risk, legal, brand, confidentiality...QualityRiskWork at officeFlexible hours
- ...and unexpected results; recovers quickly from setbacks. Exhibits qualities of and have proven to be a great teammate. Strong verbal and... ...done. Manage internal communications regarding dependencies and risks. Develop a deep understanding of the business domain, stakeholders...QualityRiskContract workRemote work
- ...closely with Highmark Health Strategic Transformation Office and senior... ...capital spend items to test quality of assumptions and operating... ...to understand the current risk composition of the Enterprise... ...companies to calculate risk adjusted financial returns under various...QualityRiskWork at office
- ...Do you want to lead Quality Operations for a commercial small molecule manufacturing... ...partners. Our client is seeking a strategic and hands‑on leader to oversee site‑based Quality Operations... ...Chain to resolve issues, mitigate risk, and improve process robustness. Champion...QualityRisk
$18 - $20 per hour
...Supports the organization's quality program(s). QUALIFICATIONS... ...Knowledge of ICD9 and CPT coding Excellent oral and written... ...Sedgwick is the world's leading risk and claims administration partner... ...in claims administration, loss adjusting, benefits administration, and...QualityRiskWork at officeLocal areaFlexible hours$66.8k - $83.4k
...Senior Quality Analyst At Quartz, quality is more than a checkpoint... ...and partnering with business leaders to strengthen processes that... ...Your work will help identify risks before they impact customers while... .... Apply deep knowledge of coding guidelines (e.g., CPT, ICD-10,...QualityRiskContract workWork from home- ...finance teams to produce and communicate financial results for MYGA and FIA products. Role emphasizes ownership of results, risk analysis, and strategic initiatives including reinsurance and affiliate programs, with near-term leadership growth and a strong, collaborative...Risk
$65k - $75k
...seeking an experienced Desk Auto Claims Adjuster to independently manage moderate-complexity... ...claim resolution. Participate in quality reviews and maintain productivity, closure... ...Bachelor’s degree in Business Administration, Risk Management & Insurance, or a related...QualityRiskRemote work- ...goals established for the department and control all established quality assurance standards. Monitor all functions, duties and... ...repair and of customer or employee accidents Report all safety risk, or issues, and illegal activity, including robbery, theft or fraud...QualityRiskSeasonal workLocal area
$73k - $105.9k
Grounded in safety, quality, and ethics, our experts lead their fields and guide our work... ...meet shifting needs. Ability to manage risks and safety appropriately, manage... ...accessible to all. If you require reasonable adjustments to be made during the recruitment process...QualityRiskFull timeShift workNight shift$129.38k - $163.7k
...with patient care and quality standards as they relate... ...efforts for achieving strategic goals. Maintains efficient... ...and other department leaders to coordinate effective... ...perception and the ability to adjust focus. This job... ...or caustic chemicals; Risk of electrical shock Up...QualityRiskFull timeLocal areaShift workWeekend work$73k - $105.9k
Grounded in safety, quality, and ethics, our experts lead their fields and guide our work... ...meet shifting needs. Ability to manage risks and safety appropriately, manage... ...accessible to all. If you require reasonable adjustments to be made during the recruitment process...QualityRiskFull timeShift workNight shift
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