Hybrid Risk Adjustment Coding Auditor (HCC/RADV)
Clever Care Health Plan
Clever Care Health Plan is hiring a Risk Adjustment Coding Auditor to conduct retrospective and prospective coding audits, validate diagnoses, and monitor CMS RADV compliance. The role focuses on HCC coding, documentation improvement, and education for providers across a fast-growing Medicare Advantage program. Candidates should have 5+ years in MA risk adjustment or related audits, with strong knowledge of ICD-10-CM guidelines and MEAT criteria. #J-18808-Ljbffr Clever Care Health Plan
$72.8k - $80k
...This position operates on a hybrid work schedule. Candidate... ...Job Summary The Risk Adjustment Coding Auditor is responsible for conducting... ...a subject matter expert in HCC coding, diagnosis validation... ...through audit activities, RADV preparedness, chart review...RiskWork at officeRemote work- ...Distribution and performs in-depth plan coding and testing of new and existing business... ...possible solutions to save time, reduce risk, and/or reduce expenses. Create and document... ...helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude...RiskWork at office
$104.9k - $199.07k
...healthcare financing, enterprise risk management and regulatory... ...revenue across our risk adjustment portfolio. This is a selling... ...areas in healthcare, where coding accuracy, documentation integrity... ...the surrounding market (CMS-HCC models, RADV, quality programs, value-...RiskFull timeWork experience placementRemote workFlexible hoursShift work$80k - $90k
...Pharmacy Part D Auditor Huntington Beach Office - Huntington Beach, CA 92647 Overview... ...Description This position operates on a hybrid work schedule. Candidate must reside in... ...innovative ways to improve Experiment and take risks by consistently generating small wins and...RiskFull timeWork at officeRemote work$198.81k - $242.99k
...Location: Newport Beach, CA or Omaha, NE (hybrid schedule: four days in the office, remote... ...with Pricing, Product Development, Risk Management, Modeling, and Sales. Responsibilities... ...skills and attention to detail. VBA coding experience and proficiency in related programming...RiskWork at officeRemote workShift work$198.81k - $242.99k
...Modeling function. This role can be on-site, hybrid, or 100% remote. How you'll help move us... ..., tools and templates based on the model risk management policy and standards As the... ...communication skills Experience coding in Python, Visual Basic, and SQL Experience...RiskImmediate startRemote workFlexible hours$167.67k - $204.24k
...deployment. Support and comply with all Model Risk Management initiatives, documentation,... ...of experience in actuarial modeling and coding. ~ Proficiency in C#, Python, or other... ....com/lifeatpacificlife. #LI-MT1 #LI-Hybrid Base Pay Range: The base pay...RiskWork from homeRelocation packageFlexible hours1 day per week- ...Charlotte, NC. This role follows a hybrid schedule of four days in the... ...trends and any needed adjustments. Assess the impact of non-guaranteed... ...emerging opportunities or risks.Oversee renewal rate analysis... ...Prophet models (including coding updates and user acceptance testing...RiskFull timeWork at officeRelocation packageFlexible hours
- ...standards, business policy, and contract terms. Ensure appropriate coding and system configuration of claims with the ability to extract... ...and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others,...Contract workWork at office
- ...Manager III position is based in Southern California and offers a hybrid work schedule, with approximately 30% travel required.... ...projects from start to finish including planning, resource allocation, risk management, issue management, and change management Help determine...RiskWorldwideFlexible hours
$95k - $125k
...Mechanics Bank is currently searching for a Sr. Auditor to join our team. Here at Mechanics Bank,... ...working together in person. This is a hybrid role based in Irvine, Roseville, or... ...demonstrating an understanding of relevant risks and controls and establishing effective tests...Risk16 hoursWork experience placementWork from homeFlexible hours$155.6k - $306.8k
...mentoring other FDEs through design/code reviews and feedback, while... ..., latency, cost, and model risk.Deliver production-quality code... ...Experience operating within hybrid onshore/offshore teams Familiarity... ...range estimate has not been adjusted for the applicable geographic...RiskLocal areaShift work- ...Modeling Director to join our Investment Risk Team in Newport Beach, CA. This role is in... ...enhance production processes (including code development) supporting quarterly valuation... ..., accounting leaders, and external auditors.Experience modeling and valuing corporate...RiskFull timeWork at officeFlexible hours
$103.2k - $129k
...gaps and subsequently working inter‑departmentally to mitigate the risks of the gaps. Interact with interdepartmental contacts on... ...Position Type/Expected Hours of Work: This role is a full‑time hybrid position. Days and hours of work are Monday through Friday unless...RiskFull timeMonday to FridayNight shiftWeekend work- ...specific internal control objectives and emerging risk areas. The Internal Audit Principal will... ...experience preferred Certified Internal Auditor (CIA) and/or Certified Information Systems Auditor (CISA) preferred Hybrid This role requires employees to be in-...RiskWork at office2 days per week
- ...well-established manufacturing company seeks a Senior Internal Auditor to join their dynamic team. The Senior Internal Auditor, reporting... .... This role ensures the effectiveness of internal policies, risk management processes, and may support JSOX compliance as needed....Risk
- ...Leveraging knowledge of ICD-10, CPT, and other applicable coding guidelines, this role helps optimize risk adjustment, reimbursement, quality reporting, regulatory... ...management Familiarity and understanding of CMS HCC models, Risk Adjustment coding and data validation...RiskFull timeWork at officeRemote work
$128.03k - $261.63k
...and enforce best practices and coding standards across the project.... ...job responsibilities within a hybrid work model that requires US Tax... ...ArchitectCertified in Risk and Information Systems Controls... ...disclosed range estimate has not been adjusted for the applicable geographic...RiskWork at officeLocal areaVisa sponsorship2 days per week3 days per week$93k - $191k
...coordination through established risk, legal, and compliance... ...job responsibilities within a hybrid work model that requires US Tax... ...disclosed range estimate has not been adjusted for the applicable geographic... ...US Careers Requisition code: 360431 Job ID 360431...RiskContract workWork at officeLocal areaVisa sponsorship- ...Your Role The Internal Auditor Consultant will report to the Internal Audit Senior Director... ...and effectiveness of governance, risk, management and control processes. Our... ...Other certifications are a plus Hybrid This role requires employees to be in...RiskWork at office2 days per week
- ...Senior Program Manager (Hybrid) Position Type: Contract (08-18-2025 - 01-31-2026) Location: Irvine, CA Primary Skills: Program... ...Benefits Management, Pursuit/ Proposal Management, Project Planning, Risk/Crisis Management, Project Governance, Account Management...RiskContract work
- ...specific internal control objectives and emerging risk areas. The Internal Audit Principal will... ...experience preferred Certified Internal Auditor (CIA) and/or Certified Information Systems Auditor (CISA) preferred Hybrid This role requires employees to be in-...RiskFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- Clever Care Health Plan in Southern California is seeking a Pharmacy Part D Oversight Auditor to lead independent auditing of Part D clinical compliance, MTM elements, and delegated PBM controls, ensuring timely, accurate, audit-ready documentation. You will coordinate...
$100.35k - $205k
...systems, agile resourcing models, risk, provision and compliance.... ...job responsibilities within a hybrid work model that requires US Tax... ...range estimate has not been adjusted for the applicable geographic... ...US Careers Requisition code: 352993 Job ID 352993 Tax...RiskContract workWork at officeLocal area- ...Internal Auditor Consultant The Internal Auditor Consultant will report to the Internal... ...adequacy and effectiveness of governance, risk, management and control processes. Our... ...Other certifications are a plus Hybrid This role requires employees to be in-...RiskFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- ...accurately reflects patient conditions, which is essential for risk adjustment and reimbursement in managed care. The ideal candidate will... ...least 3 years of clinical experience and knowledge of ICD-10 coding guidelines. This position requires excellent analytical and communication...RiskRemote job
- ...manage vendor ecosystems to deliver secure, scalable solutions. Hybrid work mode with on-site collaboration; relocation may be considered... ..., cybersecurity, procurement and IT to drive design decisions, risk management, and program success. #J-18808-Ljbffr Southern...RiskRelocation
- Job Description:The Third Party Risk Management (TPRM) Analyst is a senior individual contributor responsible for governing and overseeing... ...structures supporting third party outsourcing risk. This is a hybrid role (4 days per week onsite) in our Newport Beach, CA office....RiskFull timeWork at officeFlexible hours
- ...leadership on employment law, investigations, and compliance across North America. The role combines legal risk management with strategic business partnership in a hybrid work setting. Qualifications include a JD and California bar membership with 7+ years of employment law...Risk
- ...Quantitative Investment Modeling & Support to join our Investment Risk Team in Newport Beach, CA.As a Director, Quantitative Investment... ...across the investment portfolio.Support and development (including code development) for production processes including quarterly cash...RiskFull timeFlexible hours
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