Current jobs related to Risk Adjustment Coding Specialist - New York, New York - VNS Health
-
Senior Risk Adjustment Coder Specialist
2 weeks ago
New York, New York, United States Oscar Health Full timeAbout the RoleOscar Health is seeking a highly skilled Senior Risk Adjustment Coder Specialist to join our Risk Adjustment team. As a key member of our team, you will be responsible for daily operations related to Risk Adjustment, including medical record reviews, potential CMS audits, and medical record retrieval efforts.Key responsibilities include...
-
Risk Adjustment Consultant
2 months ago
New York, New York, United States CVS Health Full timeJob SummaryThe Manager, Business Consultation role at CVS Health is a critical position that requires a high degree of expertise in Risk Adjustment payment models for Medicare Advantage, ACA, and Medicaid. The successful candidate will be responsible for monitoring and managing day-to-day operations for Commercial Accountable Care Act (ACA) Prospective...
-
Risk Adjustment-Claims Specialist
2 weeks ago
New York, New York, United States CVS Health Full timeJob SummaryCVS Health is seeking a highly skilled and experienced professional to join our team as a Manager, Business Consultation. This role will be responsible for monitoring and managing day-to-day operations for Commercial Accountable Care Act (ACA) Prospective Programs.Key ResponsibilitiesAssist in managing the day-to-day complex business consultation...
-
Certified Medical Coding Specialist
1 week ago
New York, New York, United States Revenue Cycle Coding Strategies, LLC Full timeJob SummaryRevenue Cycle Coding Strategies, LLC is seeking a skilled Certified Medical Coding Specialist to join our team. As a key member of our coding team, you will be responsible for abstracting E/M, CPT, HCPCS, ICD-10-CM, modifier, and units from medical records. Your expertise will ensure accurate coding, compliance with federal and state laws, and...
-
New York, New York, United States VNS Health Full timeJob SummaryAs a Senior Manager of Statistical Analysis and Risk Adjustment, you will lead the development and implementation of comprehensive risk adjustment analytics strategies, leveraging business intelligence reporting, financial forecasting, and ROI analysis to inform decision-making. This role requires a strong understanding of risk adjustment...
-
Risk Coder Specialist
2 weeks ago
New York, New York, United States CareAbout Full timeJob Title: Risk Coder Specialist Job Summary: CareAbout Health is seeking a highly skilled Risk Coder Specialist to join our team. As a Risk Coder Specialist, you will be responsible for performing audits and monitoring of clinical documentation, analyzing medical records, and assessing the accuracy of ICD-10-CM/PCS, E&M, HCC, CPT, or HCPCS codes. You will...
-
Risk Coder Specialist
2 weeks ago
New York, New York, United States CareAbout Full timeJob Title: Risk Coder SpecialistCareAbout Health is seeking a highly skilled Risk Coder Specialist to join our team. As a Risk Coder Specialist, you will play a critical role in ensuring the accuracy and compliance of medical coding and billing practices.Job Summary:The Risk Coder Specialist will be responsible for performing audits and monitoring of...
-
Risk Coder Specialist
1 week ago
New York, New York, United States CareAbout Full timeJob Summary:CareAbout Health is seeking a skilled Risk Coder Specialist to join our team. As a Risk Coder Specialist, you will be responsible for performing audits and monitoring of clinical documentation, analyzing medical records, and assessing the accuracy of ICD-10-CM/PCS, E&M, HCC, CPT, or HCPCS codes. You will determine compliance with appropriate...
-
Inpatient/Outpatient Coding Specialist
1 week ago
New York, New York, United States NYC Health Hospitals Full timeJob SummaryThe Inpatient/Outpatient Coding Specialist is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate.The ideal candidate will have a strong understanding of coding/classification...
-
Risk Management Specialist
1 month ago
New York, New York, United States Corporate Risk Solutions, LLC Full timeJob Title: Vice President/Senior Vice PresidentCorporate Risk Solutions, LLC is seeking a highly skilled and experienced professional to join our team as a Vice President/Senior Vice President. This role will be responsible for leading and executing key areas within our risk management practice, including Stewardship Advisory services and Transaction...
-
Risk Adjustment Consultant
6 days ago
New York, New York, United States CVS Health Full timeAt CVS Health, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose drives our commitment to make healthcare more personal, convenient, and affordable. As a Manager in our Business Consultation team, you'll play a critical role in transforming our culture and accelerating innovation. The Manager, Business...
-
Risk Management Specialist
2 weeks ago
New York, New York, United States Corporate Risk Solutions, LLC Full timeThe Corporate Risk Solutions, LLC (CRS) is a leading risk management and insurance advisory firm dedicated to the private equity and alternative investment community. As a key member of our team, you will be responsible for managing two core areas within our risk management practice: Stewardship Advisory services and Transaction Advisory services.Key...
-
Market Risk Specialist
4 weeks ago
New York, New York, United States The Goldman Sachs Group Full timeJob Title: Market Risk SpecialistWe are seeking a highly skilled Market Risk Specialist to join our team in New York. As a key member of our Market Risk Specialists group, you will be responsible for providing risk insight and challenge to our traders and business heads.Division and Department OverviewThe Risk Division is responsible for independent review...
-
Healthcare Professional
2 weeks ago
New York, New York, United States Hueman Risk Adjustment Full timeJob OpportunityHueman Risk Adjustment is seeking qualified Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in the New York City area. This unique opportunity offers a flexible schedule, allowing you to balance your professional goals with your personal preferences. Whether...
-
Market Risk Specialist
1 week ago
New York, New York, United States The Goldman Sachs Group, Inc Full timeMarket Risk Specialist Role OverviewThe Goldman Sachs Group, Inc is seeking a skilled Market Risk Specialist to join its Risk Division in New York. This role is a key part of the second line of defense, responsible for providing risk insight and challenge to the traders and business heads.Key ResponsibilitiesReview and analyze risk measures, including VaR,...
-
Risk and Quantitative Specialist
1 week ago
New York, New York, United States Assured Guaranty Full timeAssured Guaranty is seeking a highly skilled Risk and Quantitative Specialist to join the Economic Capital and Portfolio Risk Management Group in the Risk Management Department.Key Responsibilities:Modeling and analysis of credit risk and data in the financial guaranty marketDevelopment of internal credit risk tools from the economic capital perspective...
-
Coding Specialist
3 weeks ago
New York, New York, United States Columbia University Full timeJob Title: Coding SpecialistColumbia University is seeking a skilled Coding Specialist to join our team in Fort Lee, NJ.Job SummaryThe Department of Radiology is looking for a detail-oriented and organized individual to assist with coding and compliance tasks. The successful candidate will have a strong understanding of medical terminology and coding...
-
Inpatient/Outpatient Coding Specialist
1 month ago
New York, New York, United States Athari Full timeEmpowering Healthcare ExcellenceAthari is committed to delivering exceptional healthcare services, and we're seeking a skilled Inpatient/Outpatient Coder to join our team.Job SummaryThe Inpatient/Outpatient Coder will be responsible for conducting coding audits and education for providers, ensuring accurate medical diagnosis and procedure codes on provider...
-
Risk Management Specialist
1 week ago
New York, New York, United States Point72 Full timeJob Title: Technology Risk Management SpecialistA career with Point72's Technology Team offers a unique opportunity to be at the forefront of a rapidly evolving technology landscape. Our team of experts is constantly improving our company's IT infrastructure, experimenting with new ways to harness the power of open source solutions, and embracing enterprise...
-
Nurse Practitioner or Physician Assistant
2 weeks ago
New York, New York, United States Hueman Risk Adjustment Solutions Full timeJoin Our Team of Healthcare ProfessionalsHueman Risk Adjustment Solutions is actively seeking qualified Nurse Practitioners and Physician Assistants to join our team as part-time Health Risk Assessors (HRAs) in Central Square, NY.This unique opportunity allows you to work on your own terms, with a flexible schedule designed to meet your needs. As an HRA, you...
Risk Adjustment Coding Specialist
2 months ago
We are seeking a highly skilled Risk Adjustment Coding Specialist to join our team at VNS Health. As a key member of our Medicare Risk Adjustment team, you will play a critical role in ensuring the accuracy and compliance of our coding practices.
Key Responsibilities- Conduct thorough coding reviews of provider documentation to assign accurate ICD-10 codes and ensure compliance with CMS guidelines.
- Complete monthly internal data validation of sampled Risk Adjustment diagnoses submitted by external stakeholders.
- Responsible for ensuring completion of medical record reviews based on monthly targets set forth by the department.
- Stay up-to-date on new coding and billing guidelines, federal and state initiatives, and educate other departments on changes to regulations.
- Perform medical record compliance audits using the most up-to-date CMS guidelines and submit output to CMS to accurately capture member acuity.
- Provide audit trails for all identified HCCs in medical record reviews using audit tools.
- Identify unsupported diagnoses/HCCs for Risk Adjustment Data Validation (RADV) related projects and notify management of deficiencies.
- Support supervisor in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding reviews.
- Engage with medical practitioners to provide feedback and educational resources on best practices for medical coding.
- Report incidental findings, patterns, and trends from audits/coding projects to supervisor.
- Support manager in driving enterprise-wide risk adjustment initiatives and collaborate with Special Investigations and Compliance on medical record review and claims analysis.
- Active Certified Coder Certification through AHIMA or AAPC preferred.
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or (CRC) Certified Risk Adjustment Coder in ICD-10-CM coding preferred.
- Bachelor's Degree or equivalent work experience required.
- Minimum three years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems required.
- Strong knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS, and CPT-4 coding, coordination of benefits required.
- Ability to handle multiple priorities and meet deadlines required.
- Knowledge of HIPAA, understanding a commitment to Privacy, Security, and Confidentiality of all medical chart documentation required.
