92 certified risk adjustment coder jobs found

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the...

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the...

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the...

Quality Review and Audit Senior Analyst - RADV Job Summary: Responsible for coordination and implementation of daily processes related to IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis program. Responsible for liaising with the Initial Validation Audit Entity to ensure compliant, efficient, and successful audit processes, including but not limited to file reconciliation and appeals processes. Responsible for coordinating with Quality Mgmt to effectively and compliantly execute daily RA program operations, as identified. Participates in coding reviews of medical documentation for RA programs, as needed. Responsible for communication and reporting of daily productivity and risks associated with IFP RADV audits and other RA programs, as needed, and collaborates with internal educational team to develop necessary curriculum to ensure compliance and program excellence. Contributes to Cigna IFP...

Manager Clinical Performance & Quality Coding CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. LOCATION : This position requires 3 days per week in-office. You must be within a commutable distance of one of our aligned offices. HOURS : General business hours, Monday through Friday. (Core hours: 8-5) Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a...

Manager Clinical Performance & Quality Coding CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. LOCATION : This position requires 3 days per week in-office. You must be within a commutable distance of one of our aligned offices. HOURS : General business hours, Monday through Friday. (Core hours: 8-5) Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Summary Veterans Integrated Service Network 10 (VISN 10) Prosthetics & Sensory Aids Service is currently recruiting for a full-time, Medical Support Assistant (Advanced) GS-0679-6. The incumbent will be part of the network's Prosthetics & Sensory Aids Service located in Indianapolis, Indiana. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Internal to an agency Current federal employees of the hiring agency that posted the job announcement. Clarification from the agency All qualified candidates encouraged to apply. Open to current permanent VISN 10 Department of Veteran Affairs employees, current permanent Federal employees of other agencies and all US Citizens. Non-citizens may be appointed when it is not possible to recruit qualified citizens. NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to...

Summary The Boiler Plant Operator positions are in Facilities Management service with VA Boston Healthcare System at Jamaica Plain, MA and West Roxbury, MA. These positions are full-time at 40 hours per week. *** This is an open and continuous job opportunity announcement and may close at any time once all positions are filled.*** Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Career transition (CTAP, ICTAP, RPL) Federal employees whose job, agency or department was eliminated and are eligible for priority over other applicants. Clarification from the agency ALL US CITIZENS DIRECT HIRE AUTHORITY: This position is being filled using Direct-Hire Authority (5 CFR 337.201) for this occupation. Duties This is an OPEN CONTINUOUS ANNOUNCEMENT and will remain open until May 22, 2026. The initial cut-off date for referral of eligible applications...

Summary This position is located within VHA Vocational Rehabilitation Service. Counselors work with an interdisciplinary team to provide and coordinate a wide range of rehabilitation counseling services to Veterans with disabilities, including assessment, counseling and case management services, development of rehabilitation plans, and assistance in attaining and maintaining employment, independent living, and attaining personal goals. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below. Duties Provides developmental vocational rehabilitation services to Veterans with a wide array of psychiatric and physical disabilities and psychosocial conditions that present a myriad of barriers, to achieve competitive...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for managing a book of business and the business relationship as a strategic consultant for existing accounts directly or through intermediaries. The incumbent is responsible for renewing accounts and selling new products and services to existing accounts to ensure retention and growth of profitable business. The incumbent is responsible for complex accounts that are multi-state and non-standard and complex, involving multiple, custom products and benefit designs. This role is to be based within Highmark's footprint - NY, DE, WV, or PA. ESSENTIAL RESPONSIBILITIES Client Relationship Management & Strategy: Manage and cultivate strategic relationships at senior levels with clients, consultants, and brokers/producers to foster valued business partnerships, demonstrate business acumen, and maintain an active network. Serve as the primary pharmacy client contact for strategic...

Summary You will serve as a HUMAN RESOURCES ASSITANT (MILITARY) in the MEPS Liaison Petty Officer in Navy Recruiting Processing Station Minneapolis of the NRD MINNEAPOLIS. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency U.S. Citizens Duties You will collaborate with customers to identify and obtain missing personnel documents. You will answer questions pertaining to Human Resources policy. You will identify errors with applicant/enlistment records. You will correct data discrepancies in a human resources information system. Requirements Conditions of employment Must be a US Citizen. Must be determined suitable for federal employment. Must participate in the direct deposit pay program. New employees to the Department of the Navy will be required to successfully pass the E-Verify employment...

This position manages customer project efforts and deliver exceptional customer service throughout the lifecycle of complex projects lasting approximately 6 months or longer. The individual in this position is an exceptional representative of Red River and maintains the highest standards of professionalism, attention to detail, and responsiveness to customer requests. They are the main point of contact for our customers and manage the day-to-day activities relating to the customer projects as required, including planning, coordination, scheduling, and execution of customer project requirements. Completing projects on time, on budget, and with exceptional customer satisfaction is this position's charter. Additionally, this position interfaces with and manages the customer stakeholder team on all assigned projects and maintains a team schedule. Primary Position Tasks: Own end-to-end delivery of complex, multi-phase Professional Services projects from award through...

Summary The employee is at the full performance level for a Medical Support Assistant (Advanced), performing a full range of duties in the Syracuse VA Medical Center and has met the basic requirements for this position as outlined in VA Handbook 5005/117, Part II, Appendix G, page II-G45-6 & II-G45-7. The MSA performs a wide variety of administrative and clerical duties as a member of the health care team. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Federal employees - Excepted service Current federal employees whose agencies have their own hiring rules, pay scales and evaluation criteria. Veterans Veterans of the U.S. Armed Forces or a spouse, widow, widower or parent of a veteran, who may be eligible for derived preference Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more...

NY HELP Yes Agency Information Technology Services, Office of Title Project Manager 2 (NY HELPs) - 11183 Occupational Category I.T. Engineering, Sciences Salary Grade 23 Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF) Salary Range From $86681 to $109650 Annually Employment Type Full-Time Appointment Type Contingent Permanent Jurisdictional Class Competitive Class Travel Percentage 0% Workweek Mon-Fri Hours Per Week 37.5 Workday From 8 AM To 5 PM Flextime allowed? No Mandatory overtime? No Compressed workweek allowed? No Telecommuting allowed? Yes County Albany Street Address 625 Broadway, Floor 5 City Albany State NY Zip Code 12207 Duties Description Under the direction of a Project Manager 3, SG-25, within the New York State Office of Information Technology Services Dedicated Support - Department of Environmental Conservation, the Project Manager 2, SG-23, position will focus on initiating projects that...

This position manages customer project efforts and deliver exceptional customer service throughout the lifecycle of complex projects lasting approximately 6 months or longer. The individual in this position is an exceptional representative of Red River and maintains the highest standards of professionalism, attention to detail, and responsiveness to customer requests. They are the main point of contact for our customers and manage the day-to-day activities relating to the customer projects as required, including planning, coordination, scheduling, and execution of customer project requirements. Completing projects on time, on budget, and with exceptional customer satisfaction is this position's charter. Additionally, this position interfaces with and manages the customer stakeholder team on all assigned projects and maintains a team schedule. Primary Position Tasks: Own end-to-end delivery of complex, multi-phase Professional Services projects from award through...

Summary The Infusion Registered Nurse in Oncology/Hematology is responsible for all elements of the nursing process when providing or supervising direct patient care. The nurse assesses, plans, implements, and evaluates care based on age-specific needs and assists with coordinating care focused on education, self-management, and patient satisfaction. The Infusion RN administers medications and procedures per established policies. This position is located at University Drive Pittsburgh VAMC. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Federal employees - Competitive service Current federal employees whose agencies follow the U.S. Office of Personnel Management's hiring rules and pay scales. Federal employees - Excepted service Current federal employees whose agencies have their own hiring rules, pay scales and evaluation criteria. Internal to an...

Summary Incumbent serves as an Advanced Medical Support Assistant in the Community Care (CC) Department. Individual works at the VA Medical Center in Albany, New York providing administrative, technical support, and coordination to the Community Care Manager. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below. Area of consideration - The Public - All U.S. Citizens Duties VA Careers - Medical Support Assistant: https://youtube.com/embed/EE9c4XkaELo Total Rewards of a Allied Health Professional Scheduling: Schedules all Community Care (CC) consults as per VA Regulations and Directives, Office of Community Care (OCC) Field Guidebook (FGB) and local guidance. Assumes responsibility as the CC...

This position manages customer project efforts and deliver exceptional customer service throughout the lifecycle of complex projects lasting approximately 6 months or longer. The individual in this position is an exceptional representative of Red River and maintains the highest standards of professionalism, attention to detail, and responsiveness to customer requests. They are the main point of contact for our customers and manage the day-to-day activities relating to the customer projects as required, including planning, coordination, scheduling, and execution of customer project requirements. Completing projects on time, on budget, and with exceptional customer satisfaction is this position's charter. Additionally, this position interfaces with and manages the customer stakeholder team on all assigned projects and maintains a team schedule. Primary Position Tasks: Own end-to-end delivery of complex, multi-phase Professional Services projects from award through...

Summary Protect your homeland and defend your culture. Join USCIS, America's frontline defense against illegal foreign infiltration and fraud. As a Supervisory Immigration Services Assistant (SISA) , you will provide technical and administrative support to subordinate staff to ensure compliance with USCIS procedures, policies and regulations. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Career transition (CTAP, ICTAP, RPL) Federal employees whose job, agency or department was eliminated and are eligible for priority over other applicants. Clarification from the agency If you're ready to help safeguard the nation's immigration system and combat immigration fraud, review the HOW TO APPLY section for steps to prepare for your online applications. Duties The responsibilities described are for the full performance level. At developmental grade...

Summary The Western NY VA Health care system is currently recruiting for one Rehabilitation Counselor located within the Behavioral Care Service Line. Rehabilitation Counselor will be responsible for the delivery of working with interdisciplinary teams to provide and coordinate a wide range of rehabilitation services to Veterans with disabilities. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below. Duties Rehabilitation Counselor Duties include: Provide a variety of professional rehabilitation counseling services such as personal adjustment counseling, therapeutic rehabilitation interventions and case coordination services. Uses evidence-informed and evidence-based modalities to aid Veterans with...

Summary The physical location of the position is in the Emergency Department, Richard L. Roudebush VAMC. The overall purpose of the position is to assist and serve medical providers and nursing staff in the Emergency Department in collecting and performing a variety of tasks related to diagnostics and procedures within their scope of practice, as well as the completion of clerical and administrative duties. This position is designed to fully support all Emergency Department function. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency ALL US CITIZENS DIRECT HIRE AUTHORITY: This position is being filled using Direct-Hire Authority (5 CFR 337.205) for this occupation. Duties The duties of the position may include but are not limited to the following: Major Duties: Administrative - Handles Clerical/ Administrative Support...

Summary The incumbent will provide work relating to the care and treatment of patients in inpatient units, outpatient clinics, patient scheduling call centers, Care in the Community Support Staff, and ancillary support services. Serves as a point of contact for the units, clinics, patient, call centers, CitC, to include, but not limited to, scheduling appointments, tracking, reviewing, and responding to electronic orders, consults, and other elements in the patient record and medical systems. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Internal to an agency Current federal employees of the hiring agency that posted the job announcement. Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below. This job is open to current permanent Department of Veteran...