Compliance Risk Adjustment Manager
Virtual Vocations Inc
Managing a team responsible for external audits, the full-time Compliance Risk Adjustment Manager will ensure compliance and reporting accuracy while working remotely from anywhere in the Continental United States. Key responsibilities Serve as the point of contact for external audits and manage deliverables submission to state and federal regulatory agencies Conduct quality reviews of audit deliverables for completeness and accuracy before submission Prepare and present reports on risk adjustment audit performance and collaborate with internal partners on identified risks Required qualifications Bachelor's Degree in Audit, Compliance, Legal, or related field, or equivalent experience 5+ years of experience in audit, risk adjustment, and/or compliance Demonstrated understanding of the risk adjustment regulatory landscape Active Coding Credential from AHIMA or AAPC preferred Medicare experience preferred
- ...Managing business processes related to risk adjustment and quality improvement, the full-time Remote New York Risk Adjustment Manager will develop action plans, implement operational workflows, and evaluate strategies across various departments for assigned products and...SuggestedFull timeRemote work
- ...Documentation & Coding ManagerThe Documentation & Coding Manager provides leadership and operational accountability... ...that strengthen documentation accuracy, coding compliance, provider experience, and risk adjustment performance.Essential Duties and ResponsibilitiesLead...SuggestedContract workWork at officeLocal areaRemote work
$61.5k - $98.4k
...REMOTE - Medical Risk Adjustment Vendor Manager - R9405 Join to apply for the REMOTE - Medical Risk Adjustment Vendor Manager - R9405 role at CareSource... ...and completeness of Risk Adjustment (RA) data and ensure compliance with all CMS regulations and guidelines Identifies trends...SuggestedFull timeWork experience placementWork at officeRemote work- ...Risk Adjustment Manager CoxHealth is a leading healthcare system serving 25 counties across southwest Missouri and northern Arkansas. The... ...adjustment operational strategies and processes. Ensures compliance with all policies and risk adjustment regulations. Education...Suggested
$157.3k - $262.7k
## Director, Risk AdjustmentApply: California-Remote: Full time... ...• Develop and execute a risk adjustment strategy aligned to organization... ...with Network Performance, Compliance and other teams to deliver provider... ...degree in Health Information Management, Healthcare administration,...SuggestedFull timeRemote work- ...’ needs in mind. We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for... ...with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management...Work at office
$160k - $195k
...Sr. Director - Risk Adjustment Department: Quality - Risk Adjustment Employment Type... ...Clinical Operations, Quality, Network Management, Analytics, and executive leadership.... ...provider operations, analytics, quality, compliance, and finance teams. Monitor program...Full timeContract workRemote work$87.7k - $157.8k
...Postition Purpose: Manages a team responsible for facilitation and leading external audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit... ...prevention, detection, and correction of compliance issues as identified in external audits....Full timePart timeWork at officeRemote workWork from homeFlexible hours- ...Providing executive leadership for risk adjustment performance, the full-time Senior Director of Risk Adjustment will manage cross-functional initiatives to enhance coding accuracy, documentation quality, and provider performance while working remotely. Key responsibilities...Full timeRemote work
- ...Connecticut’s most comprehensive health system Medical Director, Risk Adjustment Hartford HealthCare, Connecticut Shape the Future of Value-... ...practice while maintaining the highest standards of compliance and documentation integrity Key Responsibilities Strategic Leadership...Full time
- ...capital strategy: the remit is a defined ACA risk adjustment function rather than enterprise capital... ..., and strategic analytics while managing an actuarial team and partnering across... ...specific healthcare laws, regulations, and compliance requirementsDomain ACA risk adjustment...Remote work
$118.6k - $157.14k
...an authentic experience!Reporting to the Director of Risk Adjustment Prospective Programs, the Manager of Risk Adjustment Encounter Data Reconciliation is... ...infrastructure, data reconciliation, and risk adjustment compliance, this role executes strategies and transforms them...Temporary workWork experience placementLocal areaRemote workMonday to Friday$150k - $206.3k
...our caring community The Director, Risk Management identifies and analyzes potential sources... ...position. The Director of Risk Adjustment Regulatory Audits will be responsible... ...to the Associate VP, Risk Adjustment Compliance. High Level Responsibilities Successful...Full timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$154.13k - $204.21k
...experience! Reporting to the Vice President, Risk Adjustment, the Director of Risk Adjustment... ...are documented accurately to CMS compliance standards in real time, driving revenue... ...and improving proactive clinical care management. Commitment to Quality: The IEHP Team...Temporary workLocal areaImmediate startRemote workMonday to FridayFlexible hours- ...Description: Summary The Supervisor, Risk Adjustment Quality Assurance and Auditing, is responsible... ...team. This role ensures the accuracy, compliance, and quality of the risk adjustment... ...leadership, training, and performance management to audit staff while driving...Contract workRemote workWork from homeHome office
$149.5k
...days) to receive an alert: Director, Risk Adjustment Strategies and Initiatives Job... ...for regulatory submissions and ensures compliance with all applicable regulatory agencies... ...Responsible for supporting the organizational, management and development of risk adjustment...Full timeWork at office- ...Optum in New York, NY is seeking an Executive Director of Risk Adjustment to lead enterprise risk adjustment strategy and operational performance... ...with provider organizations, clinical leadership, and compliance teams to embed risk workflows into care delivery while...
$134.6k - $230.8k
...Growing together. Job Description - Executive Director of Risk Adjustment (2381661) Executive Director of Risk Adjustment - 2381661... ...into clinical workflows while maintaining regulatory compliance and audit readiness. Primary Responsibilities: Lead...Minimum wageFull timeWork experience placementLocal areaWork from homeMonday to Friday- ...Medical Director, Risk Adjustment | Hartford HealthCareLocation: Hartford, ConnecticutHartford... ...rates, documentation quality, and compliance.Participate in the development of annual... ...documentation requirements, chronic disease management, and risk-adjusted payment...
- ...Doctor's Choice Placement Services, Inc is seeking a Medical Director specializing in Medicare Risk Adjustment, with options to be based in Puerto Rico or Florida. This full-time position involves reviewing outpatient/inpatient medical records and ensuring proper documentation...Full time
- ...Medical Director - Medicare Risk Adjustment HCC Review - Puerto Rico (Option to be Florida... ...clinicians and internal staff. Advise management of possible trends in inappropriate utilization... ...-of-care issues. Develop and ensure compliance with policies, procedures, bylaws,...Full timeLive inWork at officeMonday to Friday
- ...matter expertise and support for program management activities. Supports programmatic... ...experience supporting provider engagement, risk adjustment, quality improvement, or similar... ...respective program(s).Collaborates with legal, compliance, information technology (IT),...Work at office
$83.99k - $119.97k
...Program Manager, Risk Adjustment & StarsAre you looking to work for a company that has been recognized for over a decade as a Top Place to Work... ...to Alpine executive leadership and payer partners.Compliance & GovernanceEnsures all program activities comply with CMS...Work at officeRemote work- ...Humana Inc. is seeking a Director, Risk Management focused on external risk adjustment regulatory audits. This remote role reports to the Associate VP, Risk Adjustment Compliance and requires leading audits, developing strategy, and cross-functional coordination to improve...Remote work
- ...Humana Inc. is seeking a Director of Risk Adjustment Regulatory Audits to develop strategy and execute external audits, ensuring strong... ...position is remote, reports to the Associate VP, Risk Adjustment Compliance, and includes potential bonus incentives based on #J-18808...Remote work
- ...Humana Inc. is seeking a Director, Risk Adjustment Regulatory Audits to strategize and drive execution of external risk adjustment regulatory... ...position reporting to the Associate VP, Risk Adjustment Compliance. The role requires extensive experience in program...Remote work
$196.73k - $286.9k
...hiring a Senior Director, Actuarial - Risk Adjustment to join our Actuarial team. Oscar is the... ..., and strategic analysis. You manage a team and partners across Finance, Market... ...specific healthcare laws, regulations, and compliance requirements. Fellow of the Society...Full timeRemote workWork from homeHome office- ...deliver tailored programs including case management, in-home and in-clinic wellness... ...PURPOSE The Manager of Coding and Risk Adjustment is responsible for leading coding operations... ...Advantage, HEDIS, STARS, and coding compliance while ensuring departmental goals, coding...Full timeRemote work
$127.34k - $216.47k
...talents and strengths. The Director of Risk Adjustment, reporting to the Vice President of... ...opportunities. This role oversees an Analytic Manager and Coding Manager that are accountable... ..., provider engagement, and full compliance with official coding guidelines and program...Full timeWork experience placementWork at office$147.55k - $215.18k
...Hi, we're Oscar. We're hiring a Senior Manager, Actuarial - Risk Adjustment to join our Actuarial team. Oscar is the first health insurance company... ...audit deliverables and maintain internal control compliance to support accurate financial reporting. Promote and...Full timeRemote workWork from homeHome office
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