• Risk Adjustment Trainer

    Datavant (Austin, TX)
    …and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of health insurance plans operations + Deep… more
    Datavant (05/07/25)
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  • Risk Adjustment Representative

    Humana (Austin, TX)
    …for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Representative 3 ensures coding is accurate and properly ... caring community and help us put health first** The Risk Adjustment Representative 3 conducts quality assurance...as well as internal policies and guidelines while analyzing coding information and medical records. May participate in provider… more
    Humana (05/07/25)
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  • IPA Coding Associate Director

    CenterWell (Austin, TX)
    …clinical documentation. + Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, ... provider coding improvement opportunities, risk score trending and tracking. + Partners with MRA...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions.… more
    CenterWell (04/24/25)
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  • AAPC Certified Medical Coding Instructor…

    Humana (Austin, TX)
    …a focus on learning strategies and adult learning theories + Working knowledge of Medicare Risk Adjustment and/or Stars + Experience using Articulate ... community and help us put health first** Certified Medical Coding Instructor (CPC-I): This is a Senior Learning Design...Information This role will be responsible for supporting the Medicare Risk Adjustment Team within… more
    Humana (05/03/25)
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  • HCC Coding Compliance Assistant

    Kelsey-Seybold Clinic (Pearland, TX)
    …or CPC (Certified Professional Coder) or CPC-A or CRC (Certified Risk Adjustment Coder) Preferred: N/A **Special Skills** Required: Analytical. ... detail. Efficient. Flexibility. High work ethic. Team building. Preferred: Knowledge of Medicare and other government or third-party coding rules. Working… more
    Kelsey-Seybold Clinic (04/23/25)
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  • Clinical Data Abstraction Specialist

    Apex Health Solutions (Houston, TX)
    …Current AAPC or AHIMA credential required. Managed Care Experience preferred. Knowledge of Medicare Risk Adjustment required. About Apex Health Solutions ... inpatient and/or outpatient medical records to ensure proper ICD-10 coding and compliance with risk adjustment...ensure proper ICD-10 coding and compliance with risk adjustment requirements. Essential Duties and Responsibilities… more
    Apex Health Solutions (04/25/25)
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  • Quality Practice Advisor - Medical Affairs

    Centene Corporation (Houston, TX)
    …closing health care gaps for patients + 3+ years of working directly with HEDIS measure, Medicare STAR ratings, and Risk Adjustment knowledge - 90% of role ... regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment . Provides education for HEDIS measures, appropriate medical… more
    Centene Corporation (04/27/25)
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  • Sr Analyst, Medical Economics (Medicaid) - REMOTE

    Molina Healthcare (Dallas, TX)
    …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job Qualifications** **Required… more
    Molina Healthcare (04/16/25)
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  • Sr Analyst, Medical Economics (Clinical Analytics…

    Molina Healthcare (TX)
    …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), + Diagnosis Related Groups ... lead to value + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job...and other payment mechanisms. * + Understanding of value-based risk arrangements + Experience in quantifying, measuring, and analyzing… more
    Molina Healthcare (04/12/25)
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  • Compliance Nurse 2

    CenterWell (Austin, TX)
    …rehab + Previous experience working in/with the primary care setting + Risk adjustment experience + Auditing experience + Coding background + Ability to work ... knowledge + Health Plan experience working with large carriers + Previous Medicare /Medicaid experience a plus + Previous experience in chronic disease management,… more
    CenterWell (05/08/25)
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