- Avera (Sioux Falls, SD)
- …initiatives and Healthcare Effectiveness Data Information Sets (HEDIS). The Quality and Risk Adjustment Specialist will work closely with the Director of ... Quality and Risk Services, Manager of Risk Adjustment...providers to ensure that proper clinical documentation. The QRA Specialist will be responsible for ensuring that medical records… more
- Good Samaritan (Sioux Falls, SD)
- …the assigned area(s) of nursing. Will incorporate responsibilities related to the quality risk and risk score adjustment programs. Assist with the ... experience. Experience and knowledge of accreditation and regulatory agency standards preferred. Quality , medical coding, and/or risk adjustment experience… more
- Travelers Insurance Company (Pierre, SD)
- …complex claims, in multiple jurisdictions, in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while ... file exposure is greater than $2 million. + Provide quality customer service and ensure file quality ...activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants and fire or fraud investigators… more
- CVS Health (Pierre, SD)
- …or CCS-P (Certified Coding Specialist -Physician) required. + CRC (Certified Risk Adjustment Coder) + Computer proficiency including experience with Microsoft ... for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in… more