Risk Adjustment Compliance Coding Specialist, Consultant
On-siteOakland, California, United States
EXPIREDOakland, California, United StatesOn-siteFull TimeHealthcare TechLarge
Full TimeLargeHealthcare Tech
Job Summary
Review clinical documentation and medical records to verify that all diagnoses and procedures are properly captured and coded in accordance with regulatory standards. Ensure organizational compliance with laws related to Risk Adjustment across the Marketplace (ACA), Medi-Cal (Medicaid), and Medicare Advantage lines of business. Maintain the accuracy, completeness, and integrity of medical coding for risk adjustment programs to support appropriate reimbursement, accurate risk stratification, and quality improvement efforts.
Required Qualifications
- Knowledge of laws related to Risk Adjustment across Marketplace (ACA), Medi-Cal (Medicaid), and Medicare Advantage lines of business
- Ability to ensure the accuracy, completeness, and integrity of medical coding for risk adjustment programs
- Ability to review clinical documentation and medical records to verify that all diagnoses and procedures are properly captured and coded in accordance with regulatory standards
- Ability to help healthcare organizations meet compliance requirements for federal and state risk adjustment initiatives
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