Risk Adjustment Representative 2
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Quality assurance audits of medical records for Medicare and Medicaid programs. Conducting administrative tasks while ensuring compliance and accuracy in a remote environment.
Responsibilities:
- Conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes
- Performs varied activities and moderately complex administrative/operational/customer support assignments
- Collect medical records to ensure accuracy of member information and obtain provider signatures
- Upload verified documents to Cotiviti centralized repository
- Follow state and federal regulations as well as internal policies and guidelines while retrieving medical records
- Communicate with physician offices by phone and email to efficiently meet all deadlines
- Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines
- Independently manage workload within defined service level expectations
Requirements:
- High School Diploma
- Professional appearance and attitude
- Must have reliable transportation
- Demonstrated organizational skills
- At least 3 years of technical experience
- Proficiency in all Microsoft Office applications, including Word and Excel
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
- Excellent communication skills, both verbal and written
- Ability to travel locally 50% to 75% of the time.
- Candidate to reside within Raleigh, Fayette, Greenbrier, Nicholas, Clay, Summers, Monroe, or Mercer counties in WV.
- Ability to travel overnight occasionally
Benefits:
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- many other opportunities
Similar Jobs
Senior Risk Analyst
Senior Risk Analyst at Tabby, analyzing risk and developing fraud prevention strategies. Collaborating with teams to enhance risk management solutions.
Medicaid Risk Adjustment Market Manager
Medicaid Market Manager overseeing Risk Adjustment programs at CVS Health. Driving market engagement, performance insights, and value demonstration to senior leaders and partners.
Senior Manager, Fraud & Payments Risk
Senior Manager leading Baselane's fraud function, managing operations and team development in a fintech environment. Focused on maturing risk programs and enhancing automation as the company scales.
Governance Specialist – Support
Governança e sustentação de TI no CIEE, garantindo a disponibilidade dos sistemas e a melhoria contínua. Coordenando a gestão de problemas e estabelecendo indicadores de desempenho.
Senior Risk Management Consultant
Senior Risk Management Consultant at ICW Group identifying and quantifying insurance risks for policyholders. Working with various industries to mitigate risks and improve results.
Senior Director of Enterprise Risk Programs and Intelligence
Senior Director of Enterprise Risk Programs leading integration of risk insights for a fintech company. Collaboration with leadership to develop enterprise risk management capabilities.
Senior Data Governance Consultant
Senior Data Governance Consultant leading and executing data governance engagements for clients. Responsible for managing projects, stakeholder alignment, and delivering governance solutions remotely.
Risk Analyst II
Risk Analyst II overseeing merchant accounts to identify financial risk at Maverick Payments. Monitoring compliance and transaction activity within a family-owned payment provider.
Senior Data Governance Specialist
Senior Data Governance Specialist supporting design and implementation of data governance strategies. Ensuring reliable, accessible, and well-managed data for effective organizational analytics.
Senior Technical Investigator – Insider Risk
Senior Technical Investigator at JLL responsible for cyber investigations and insider threat management. Collaborating with stakeholders and providing expertise in technical investigations.
AVP, ESG Rating & Governance – Environment, Social & Governance
AVP for ESG Governance and Ratings developing and implementing ESG strategy in a fast-evolving landscape. Overseeing governance frameworks, managing ratings engagement, and ensuring reporting accuracy.
Director, Risk Adjustment
Director of Risk Adjustment driving healthcare risk adjustment performance across payer programs at Interwell Health. Leading strategy translation into scalable programs and operational initiatives for providers.
Director of Portfolio Construction and Risk Management
Director of Portfolio Construction & Risk Management at Wealth Enhancement overseeing portfolio frameworks and analytics. Enhancing investment processes and collaborating across teams for optimal outcomes.
Governance & Control Analyst II
Governance & Control Analyst providing analytical support for governance and control processes in the financial sector. Engaging in research, evaluation, and reporting tasks to enhance business performance.
ACA Risk Adjustment EDGE Administrator
ACA Risk Adjustment EDGE Administrator managing the CMS EDGE server operations at Cigna Healthcare. Overseeing data submissions, compliance, troubleshooting, and collaboration across teams.
ICAM Engineer – Identity Governance
ICAM Engineer - Identity Governance developing enterprise-scale Identity solutions for DoD. Designing, integrating, and maintaining identity governance systems in secure environments.
Sport Risk Manager
Sport Risk Manager handling betting operations for SOFTSWISS Sportsbook. Engaging in risk control, odds management, and performance optimisation across multiple sports and leagues.
Communications Governance Administrator
Communications Governance Administrator responsible for compliance in mortgage servicing communications. Drafting customer-facing materials and collaborating with business leaders and legal counsel.
Senior Data Architect – Data Governance, Architecture
Senior Data Architect focused on data governance and architecture in remote strategic projects. Ensuring data architecture scalability, governance, and innovation at Avantti Tecnologia.
Director, Enterprise Transformation – Governance
Director leading enterprise transformation & governance initiatives for D-Wave, a quantum computing leader. Overseeing modernization and analytics-driven operational scaling initiatives with executive collaboration.