ICD Coding & Data Quality Auditor | Risk Adjustment
CVS Health Corporation
CVS Health Corporation is seeking a quality reviewer to perform inter-rater audits of medical records coded for CMS risk adjustment. You will ensure ICD-10 accuracy, mentor staff, and communicate findings to multiple stakeholders across departments. The role requires strong coding expertise, regulatory knowledge, and exceptional analytical skills to maintain compliance and improve processes within a large healthcare organization. #J-18808-Ljbffr CVS Health Corporation
- ...medical records are coded within Medical... ...the Inpatient Coding Quality Analyst serves as a... ...and compliance of ICD‑10‑CM/PCS coding and... ...reimbursement integrity, data quality, audit... ...mitigation of DRG downgrade risk through targeted... ...case review, risk‑adjusted outcomes, and...DataRiskWork at officeRemote work
$90k - $120k
Senior Analyst, Risk Adjustment Strategy Department: Quality - Risk Adjustment Employment Type:... ...position authors and refines the coding policy and documentation... ...types, settings, and data sources support a risk-adjustable... ...change control across ICD-10-CM Official Guidelines,...DataRiskFull timeContract workRemote workWork from homeHome office$27 per hour
...Cycle Management (RCM) and Risk Adjustment services, helping... ...the highest standards of quality, information security, and... ...will review member and claim data validation aspects, which... ...Coder must have knowledge of ICD-10-CM IP and OP coding Coders will confirm or not...DataRiskHourly payRemote workFlexible hoursNight shiftWeekend work$29 - $32 per hour
...United States Full-time regular Auditor, HCC Risk Adjustment Coding Datavant is the data collaboration platform trusted for... ...Audit coded charts assigned by quality supervisor per the client guidelines... ...Extensive knowledge of ICD -10 High school diploma or GED equivalent...DataRiskFull timeWork at officeRemote workFlexible hours- ...Corporation is seeking an experienced HCC Auditor to review medical records and ensure accurate risk adjustment coding for reimbursement. This remote role requires solid ICD-10 knowledge and strong... ...coded charts, maintain a high-quality standard, participate in project...RiskRemote job
$143.62k - $229.79k
...a Consulting Actuary - ACA Risk Adjustment, you will play a pivotal role... ...timeliness, compliance, and quality of work Provide proactive and... ...partnerships with vendors, auditors, regulators, and health care... ...understanding of diagnosis coding (ICD-10-CM) , provider documentation...Risk- ...Management is seeking a Senior Analyst, Risk Adjustment Strategy to lead coding policy and documentation standards. The role reports to the Chief Quality Officer and guides coders, CDI... ...readiness. The position requires advanced ICD-10-CM knowledge, SQL/Excel skills, and...RiskRemote job
$27.02 - $48.55 per hour
## Quality Practice AdvisorApplylocations: Asheville-North... ...) HEDIS measures and risk adjustment. Provides education for... ...and appropriate coding. Assists in resolving deficiencies... ...guidelines and HEDIS ICD-9/10 CPT coding in... ...adjustment performance data to identify and strategize...DataRiskFull timePart timeH1bWork at officeRemote workFlexible hours- ...by a mission to improve the quality and accuracy of clinical documentation... ...and motivated Clinical Risk Adjustment Documentation Specialists to... ...critical role in supporting coding accuracy, HCC capture, regulatory... ...Strong understanding of: ICD-10-CM coding guidelines, HCC...RiskRemote work
- ...clinical knowledge to adjust service area schedules... ...Supervises continuous quality improvement efforts, establishes... ...progress, prepares data for presentation, and... ...site or contact Risk Management/Employee Health... ...terminology, basic ICD 10 and CPT coding, healthcare program...DataRiskFull timeWork at officeDay shift
- ## QA Coding SpecialistApplylocations: United Statestime type: Full... ...is responsible for performing quality reviews of onshore and offshore... ...95% accuracy rate.* Analyze data, prepare reports and dashboards... ...with leadership, compliance, and risk management teams to ensure...DataRiskWork at officeLocal areaRemote work
- ...Performance Analyst to join the Performance and Risk Adjustment team. You will conduct chart reviews to code diagnoses and quality, and monitor performance with initiatives... ...and health plans. The position requires CPT/ICD-10 coding experience and AHIMA/AAPC certification...DataRiskWork at officeLocal area
- ...Asheville, NC, is seeking a Quality Practice Advisor to build strong... ...while advancing HEDIS and risk adjustment initiatives. This role requires... ...record documentation, and coding practices. The ideal candidate... ...equivalent and 3+ years in HEDIS data collection and coding, with...DataRiskRemote job
- ...FUNCTIONS** Performs high quality diagnostic... ....* Responsible for coding signs and symptoms,... ...procedures in accordance to ICD-10-CM and CPT... ...available clinical data in order to alert... ...equipment calibrations adjustments.* Reports equipment... ...or significant risk to the health and safety...DataRiskContract workShift workAfternoon shift
$65k - $92k
...Responsibilities:*** Query claims data warehouses to identify... ...medical policy and CMS coding conventions.* Identify... ...duplicates.* Apply CPT, HCPCS, ICD-10, and **DRG**... ...net recovery per finding, adjusting for denial rates and appeal risk.* Produce structured documentation...DataRiskHourly payFull timeWork at officeLocal areaRemote workWork from homeMonday to Friday- ...Hospice by Compassus Clinical Quality Specialist - RN About Mercy Health... ...responsible for upholding the Code of Ethical Conduct and for... ...including visit utilization, LUPA risk, recertification... ...reviewing reports, analyzing data, and operating standard office...DataRiskTemporary workWork at officeRemote work
$96k - $125k
...complex clinical and financial data into narratives that drive... ...sits at the intersection of risk adjustment, quality measurement, utilization... ...metrics: risk adjustment (HCC coding, RAF scores), utilization (IP... ...with clinical terminologies: ICD-10, CPT/HCPCS, NDC, SNOMED,...DataRiskWork experience placementWork at officeRemote workFlexible hours$125.6k - $172.7k
...of health, material and data science that change... ...staff to assure target quality and production levels*... ...services consulting or coding functions in mid-to-large... ...outsourced CDI group* Strong ICD-10-CM/PCS coding, ICD-1... ...; Working knowledge of risk-adjusted methodologies (e.g.,...DataRiskRemote jobH1bRelocation packageFlexible hours$157.25k - $212.75k
...clinical medicine, health care quality benchmarking, and applied data science/AI. This person... ...gaps that affect risk adjustment, mortality index, and quality... ...expert bridging quality, coding/CDI, clinical operations,... ...Deep working knowledge of ICD‑10‑CM/PCS coding, risk‑...DataRiskFull timeTemporary workLocal areaRemote workFlexible hours- ...address your business’s unique risks. MSIG Holdings (U.S.A.), Inc.... ...This position is responsible to adjust assigned claims within... ...counsel; directs and monitors quality and performance of defense counsel... ...Completes timely and accurate data reports to state reporting agencies...DataRiskLocal area
$85k - $110k
...alternative application process. Quality Assurance & Compliance... ...general liability, auto, builder’s risk, professional liability, and workers... ...requirements, and privacy and data handling obligations governing... ...reports, and dashboards for adjusters, managers, and senior...DataRiskFull timeFlexible hours$24 - $43 per hour
...the care, pharmacy benefits, data and resources they need to feel... ...member of the Performance and Risk Adjustment team. Conducts chart review to code for diagnoses and quality. Monitors performance and participate... ...working with CPT and ICD-10 codes and reading claims forms...DataRiskHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaRemote workShift work- ...Summary The Hospital Auditor is responsible for... ...guidelines and coding standards. This role... ...strengthen documentation quality, promote compliant... ...alignment with ICD‑10‑CM/PCS, MS‑DRG/APR... ...trends and risks, and prepare detailed... ...documentation quality, data integrity, and compliance...DataRisk
$31.86 - $47.79 per hour
...FUNCTIONS****:*** Collects patient health data for physician, enters into the EMR.*... ...toward attainment of outcomes.* Assigns ICD-10 codes on charge sheets for billing office and monitors... ...of medication infusions and high-risk medications including but not limited to:...DataRiskWork at officeFlexible hoursShift work- ...manage complex financial data across multiple... ...systems. Ensuring accurate coding and timely processing of... ...early‑phase financial risk. Prepare and manage accounts... ...deliverables meet quality standards prior to ownership... ..., and the ability to adjust focus. The employee may...DataRiskContract workFor subcontractor
$200k
Job Summary The Coding Supervisor is responsible for... ...leadership, training, and quality assurance for coding... ...RHIT, RHIA). Certified Risk Adjustment Coder (CRC) preferred.... ...role. Strong knowledge of ICD-10, CPT, HCPCS, and... ...have the ability to enter data within company's computer...DataRiskHourly pay16 hoursFull timeTemporary workPart timeWork at officeLocal areaImmediate startRemote workRelocation packageFlexible hours$149k - $186k
...name on itWe are looking for a Data Science Manager for our Sports... ...closely with the product and risk and trading teams, modeling player... ...contribute to a collaborative code environment.In addition to the... ...a workplace accommodation or adjustment during the application and...DataRiskTemporary workLocal areaWorldwide$140 - $150 per hour
...empathy, and a commitment to high-quality service, all aimed at putting... ...regulations. Ensure accurate ICD-10 coding and sequencing based on each... ...to resolve documentation and data integrity issues. Monitor... ...and flag potential financial risks or underutilization to clinical...DataRiskDaily paidFull timeFlexible hours- ...expertise in payer guidelines, coding conventions, and... ...requests. Applies knowledge of ICD‑10, CPT, and HCPCS... ...clinical and financial data. Resolves escalated authorization... .... Participates in quality assurance, training, and... ...(10%–50% of the time). Risk of back injury from...DataRiskFull timePart timeReliefInternshipShift work
- ...Weekly Hours: 40 JOB SUMMARY Quality Coordinator Specialist plays a... ...complex clinical and operational data into actionable insights that... ...gaps, and emerging risks. Translates raw data into meaningful... ...measure specifications, risk‑adjustment methodologies, and regulatory...DataRiskLocal area
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