of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition capture (HCC) codes, risk adjustment... /Elixhauser variables and other risk adjustment variables. · Meets revenue cycle goals (Key Performance Indicators (KPIs...
measures, and risk adjustment initiatives. Present payer and performance scorecards to review benchmarks, identify gaps... for HEDIS/STAR and risk adjustment benchmarks. Analyze practice-level data and scorecards to identify trends, gaps...
submission. The Actuarial Analyst, Consultant, will report to the Manager of Risk Adjustment Retrospective Analytics...Job Category: Actuarial Services Job Description: Your Role The Risk Adjustment Retrospective Analytics team...
/practices related to risk adjustment, coding, and clinical documentation improvement. Assess workflow processes in physician..., coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue...
Senior AI Engineer, Business Solutions ClearBridge Investments is a leading global equity manager with over $180... to internal builds, quantify TCO, lock in risk, compliance posture, and speed to value. Present recommendations and rollout plans...
. Strategically audits cases in regard to Denial Prevention, Quality comorbidities, Risk Adjustment related data audits, and Quality... represent the severity of illness, risk of mortality, length of stay, intensity of service, and hospital quality metrics...
About the role This role is on our Worldrisk line of business and assists the underwriters by screening risk... traditional UA duties, this role will: Support regional UA Manager in overseeing all daily business activities and act as the...
), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC) by AAPC, or Certified Coding Specialist... productivity report to HIM manager by defined deadline. Meets and maintains HIM coding quality and productivity standards. Attends...
launch. Stay ahead of regulatory and payer trends (CMS rules, MA and risk adjustment, value-based care, interoperability... Intake, Capacity Logistics, Care Coordination, and Revenue Cycle Management (RCM). As the general manager and portfolio...
on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data... Validation (RADV) audits, compliance risk-based audits, support external audit coordination, and ensure alignment with CMS...
assignment and sequencing of risk adjustment diagnoses following established guidelines. Reviews work queues to identify charts... billing/abstracting systems using established professional and regulatory coding guidelines. Ensures that each diagnosis...