• Risk Adjustment Audit…

    Molina Healthcare (Madison, WI)
    …and confirm required data elements. + Collaborate with internal teams-including IT, Risk Adjustment operations , and clinical teams-to ensure accurate ... Analyst will play a supporting role on the RADV ( Risk Adjustment Data Validation) team, assisting in...team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of… more
    Molina Healthcare (08/08/25)
    - Related Jobs

  • Director, Prospective + Concurrent Risk…

    Datavant (Madison, WI)
    …vision for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
    Datavant (08/08/25)
    - Related Jobs

  • Auditor, Risk Adjustment (Remote)

    Molina Healthcare (Madison, WI)
    …chart retrieval, file transmissions, and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, ... the daily operations of all aspects of risk adjustment data validation related activities, including,...adjustment payment in all markets * Performs monthly audit on internal Molina Coding Specialists * Audits external… more
    Molina Healthcare (07/25/25)
    - Related Jobs

  • Director, Clinical Data Acquisition (HEDIS…

    Molina Healthcare (Madison, WI)
    …for HEDIS, or HEDIS-like projects, Risk Adjustment , Risk Adjustment Data Validation, and other state specific audit projects and deliverables. This ... * Experience developing performance measures that support business objectives. + HEDIS Operations experience. + Risk Adjustment and Data Validation… more
    Molina Healthcare (08/21/25)
    - Related Jobs

  • Client Coding Project Manager - Full Time - Remote

    Datavant (Madison, WI)
    …key role in ensuring coding compliance and accuracy + Monitor the performance of the Risk Adjustment Operations both internally and with coding vendors + ... The individual will provide superior quality by performing audits pertaining to risk adjustment coding efforts. The individual will be responsible for… more
    Datavant (07/26/25)
    - Related Jobs

  • Sr Compliance RCM & Coding Auditor

    Humana (Madison, WI)
    …analyze large data sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment , pharmacy knowledge a plus + Certified Coder (CPC, CRC, ... Regulatory Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the… more
    Humana (08/23/25)
    - Related Jobs

  • Security and Loss Prevention Expert, NA

    Amazon (Madison, WI)
    …of work with security vendors * 2+ years of operational experience in risk management, audit , data analytics, inventory control, quality assurance, retail, ... to sites with stairs). * This role covers 24/7 operations and must be able to work all shifts,...subjectivity, complexity, and variation; identifying, preparing for, and mitigating risk ; and auditing our practices to ensure compliance. Basic… more
    Amazon (09/03/25)
    - Related Jobs