Risk Adjustment Coding Auditor
ClinDCast LLC
Empowering the Future of Healthcare The healthcare industry is on the brink of a paradigm shift where patients are increasingly being viewed as empowered consumers, utilizing digital technologies to better understand and manage their own health. As a result, there is a growing demand for a range of patient-centric services, including personalized care that is tailored to each individual's unique needs, health equity that ensures access to care for all, price transparency to make healthcare more affordable, streamlined prior authorizations for medications, the availability of therapeutic alternatives, health literacy to promote informed decision-making, reduced costs, and many other initiatives designed to improve the patient experience. ClinDCast is at the forefront of shaping the future of healthcare by partnering with globally recognized healthcare organizations and offering them innovative solutions and expert guidance. Our suite of services is designed to cater to a broad range of needs of healthcare organizations, including healthcare IT innovation, electronic health record (EHR) implementation & optimizations, data conversion, regulatory and quality reporting, enterprise data analytics, FHIR interoperability strategy, payer-to-payer data exchange, and application programming interface (API) strategy. ClinDCast LLC
- Oscar Health is hiring a remote Associate, Risk Adjustment Auditor to join their Risk Adjustment team. This role involves conducting internal and external quality audits specific to ICD-10 code accuracy. The ideal candidate will have experience in risk adjustment coding...RiskRemote job
- ...A healthcare consulting firm is seeking a professional for a coding role focused on Medicare and Medicare Advantage initiatives.... ...ideal candidate will have at least one year of experience in risk adjustment coding and hold an active coding certification. This position...RiskHourly pay
- ...A healthcare technology company is seeking a Coding Associate responsible for delivering high-quality risk adjustment coding services for clients. This role requires reviewing medical records, assigning diagnosis codes, and ensuring compliance with CMS standards. Required...RiskRemote work
$143.62k - $229.79k
...Description As a Consulting Actuary - ACA Risk Adjustment, you will play a pivotal role in... ...Manage external partnerships with vendors, auditors, regulators, and health care providers,... ...Preferred Strong understanding of diagnosis coding (ICD-10-CM) , provider documentation...Risk- ...COMPLIANCE AUDITOR page is loaded## COMPLIANCE AUDITORremote type: On-sitelocations: NY Brooklyn... ...to proactively conduct effective risk assessments and assist in preparing annual... ...guidelines, and regulations.* Billing and Coding experience, preferred.* Strong attention...RiskLocal area
- ...supervises, and performs medical record audits of documentation, coding and billing for technical and professional services, including:... ...activities with Internal Audit, as necessary. Identifies compliance risk areas and develops action plans accordingly. Develops and...RiskFor contractorsWork at officeLocal area
$81.6k - $102k
...supervises, and performs medical record audits of documentation, coding and billing for technical and professional services, including:*... ...with Internal Audit, as necessary. • Identifies compliance risk areas and develops action plans accordingly. • Develops and coordinates...RiskFor contractorsWork at officeLocal areaShift work- Coding Auditor This position is responsible for providing Quality Assurance and coding audit services for risk adjustment purposes, supporting ACA Commercial, Medicare and Medicaid programs. Your Responsibilities Experienced coder who has participated in Regulatory Audits...Risk
$69k - $160k
...Description Vice President, Technology Auditor, Cybersecurity At BNY, our... ...software. Understand Data Protection risks and strategies Apply knowledge of key... ...FFIEC Handbook. Knowledge of scripting/coding such as Java, Go, C, C+ C#, Ruby, Perl, Python...RiskTemporary workWork experience placementWorldwideFlexible hours$85k - $200k
...disputes seeks a Sr. Associate to utilize their expertise in coding, revenue cycle, and clinical operations. Responsibilities include... ...with regulations. Candidates should be certified in Risk Adjustment Coding (CRC) with strong analytical and communication skills....RiskRemote work- ...together. In this position as a Clinical DRG RN auditor, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10... ...conditions that impact severity of illness (SOI) and risk of mortality (ROM) 2+ years of ICD-10-PCS...RiskTemporary workWork at officeRemote workRelocation package
- Medicare Risk Adjustment Coding Specialist- Remote American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership...RiskRemote jobFull timeTemporary workLocal area
$85k - $200k
...Sr. Associates use their experience and knowledge related in coding, revenue cycle and clinical operations, along with their project... ...additional opportunities for development in a variety of risk adjustment related areas. Qualifications: Certified in Risk Adjustment...RiskRemote work- ...process. 2. Identify and rectify missing or incorrect charges, coding errors, and inconsistencies between documentation and billing.... ...Centers for Medicare and Medicaid Services (CMS). 6. Mitigate the risk of compliance violations, audits, and potential penalties...RiskLocal area
$165k - $185k
...Inspection / Audit Job title VP Lead Auditor - Financial Controls and Regulatory... ...deliverables and, under the supervision of the Risk and Finance Audit Supervisor and... ...fieldwork carried out by the team and to adjust the fields of audit to the risks identified...RiskPermanent employmentContract workLocal areaImmediate start$70k - $75k
...Financial Services & Insurance Attorney Auditor ** This is a fully remote position,... ...roles. Sedgwick is the world's leading risk and claims administration partner, which... ...solutions in claims administration, loss adjusting, benefits administration, and product recall...RiskLocal areaRemote workWork from homeFlexible hours- ...Claims Manager Position Reports To: Director Risk Management / General Counsel Position... ...Responsible for oversight of carrier and TPA adjusters and application of loss reduction... ...activities including, but not limited to, bill coding and payment processing, as assigned....RiskWork at office
- ...maintenance, financial, administration and risk management. As an on‑site leader, you... ...identify trends and recommend strategies and adjustments. Develop yearly operating budgets/... ...Monitor the timely receipt, reconciliation and coding of all vendor invoices. Ensure property...RiskPermanent employmentFull timeFor contractorsWork at office
- Physician Coding Auditor Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty services... ...score audits utilizing proper scoring methodology; Identifies risk areas and provides mitigation strategies and recommendations;...RiskPermanent employmentLocal areaRemote workFlexible hours
$36 - $41.25 per hour
...Description Job Description Internal Auditor Staff is responsible for assisting with... ...assisting in developing project-level risk assessments. Actively participate in meetings... ...as Excel, ACL, Tableau etc. Python or coding is preferred but not required....Risk- ...enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions.... ...plans can confidently plan and execute risk, quality, and member management programs... ...to changes in the work environment; adjusts methods to best fit the situation; able...RiskLocal areaRemote workFlexible hours
- ...company expertise. Our Crop Division has been helping farmers manage risk since 1915 and is one of the few private companies authorized by... ...part‑time. Hours fluctuate based on seasonal needs. As a Crop Adjuster, You Will Understand and work claims for all major crops,...RiskFull timePart timeSeasonal work
$80k - $100k
...) About the Role A growing public accounting firm is seeking an Auditor to join its audit and assurance team. This position offers the opportunity... ...Evaluate internal controls, financial reporting processes, and risk areas during engagements Identify issues, recommend solutions,...Risk- ...responsible to perform their job practicing good risk management, quality assurance, and... ...guidelines in regards to compliance, ie, Coding practices. Attends patient care... ...vision, depth perception, and the ability to adjust focus. Ability to work with a moderate noise...RiskContract workDay shift
- ...tight‑knit team to evaluate and contribute to the effectiveness of risk management, control and governance processes throughout our... ...issues and offering recommendations to key decision‑makers, our auditors help minimize risks and maximize patient care performance. Information...Risk
$110k - $140k
...performs varied actuarial services including coding, building and maintaining actuarial... ...generate reports. The candidate should make adjustments and improvements to models, when... ...financial models that effectively evaluate risk. Project Management - Comprehensive - Can...RiskWork experience placementLocal areaRemote workWork from homeFlexible hours$74.16k
...Overview Auditor I role at Metropolitan Transportation Authority (MTA). Posting number 13343. Location: 2 Broadway. Employment type: Full... ...and ensure proper documentation is uploaded in the Governance Risk and Compliance (GRC) system to close the recommendations. A Auditor...RiskFull timeContract workWeekend workAfternoon shift1 day per week$72.8k - $95.5k
...analytics, Incurred but not Reported (IBNR) projections and risk adjustment accruals. You will report into the Manager, Actuarial. Work... ...apply tech-forward methods in actuarial models. Proficient in coding This is an authentic Oscar Health job opportunity. Learn...RiskFull timeWork at officeFlexible hours$150k - $190k
...Senior Auditor Public Accounting Firm Location: Bergen County, NJ or Westchester County, NY Compensation: $150,000.00 - $190,000.00 per... ...financial statements and apply GAAP, ASC 606, and ASC 842. Conduct risk assessments and evaluate internal controls. Prepare and review...Risk- ...portfolio performance, monitoring key actuarial metrics including risk-adjusted rate change, actual vs. technical price, and mix of business.... ...Advanced skills in Microsoft Excel and familiarity with coding in SQL, VBA, or R/Python Experience with statistical modeling...RiskInternshipWork at office
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