Risk Adjustment Consultant

Job not on LinkedIn

🔥 5 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $72.4k - $90.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🎲 Risk

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Tufts University School of Dental Medicine

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1868

🏥 Healthcare

💼 Consulting

📚 Education

Healthcare • Consulting • Education

Tufts University School of Dental Medicine is a prestigious institution dedicated to advancing dental education, research, and patient care. As part of Tufts University, it offers comprehensive undergraduate and graduate programs in dental medicine, fostering an environment of intellectual growth and innovation. The school emphasizes a commitment to diversity and community engagement, providing students with ample opportunities for hands-on learning and research. Located near Boston, it benefits from a vibrant academic and healthcare community. Tufts University School of Dental Medicine is renowned for its contributions to dental science and its efforts to prepare students to lead in an evolving global landscape.

📋 Description

• Perform accurate and timely reviews and validations of Medicare, Medicaid, Commercial HCCs, and DxCGs through medical record reviews • Review provider documentation and verify ICD-10-CM coding against coding standards and CMS and Commercial Risk Adjustment guidelines • Evaluate HCC/DxCG coding practices and provide analyses and recommendations to improve provider documentation • Review medical records to verify ICD-10-CM and CPT codes accurately reflect provider documentation • Summarize audit findings for internal and external parties and provide provider education • Audit medical records for LCO groups and network providers to ensure diagnosis and CPT coding accuracy • Evaluate records for authorized providers, face-to-face CPT codes, signatures, and other technical requirements • Track audit results, identify trends, and recommend corrective actions • Collaborate with leadership, staff, and vendors to identify and submit coding adjustments • Provide education and feedback to physicians and network providers on risk adjustment and coding guidelines • Interpret coding guidelines and CMS regulations for leadership • Research and resolve coding and risk adjustment regulatory issues • Work retrospective/concurrent audit reports to close diagnosis gaps • Perform pre-visit chart reviews and provider outreach • Present recommendations and coding issue findings to key internal staff and leadership

🎯 Requirements

• Certified Risk Adjustment Coder (CRC) or must obtain within first 12 months of employment • Two (2) years of outpatient billing, coding, and risk adjustment experience • Associate’s degree preferred • Two (2) years of outpatient billing, coding, risk adjustment, and primary care adult medicine experience preferred • Extensive knowledge of ICD-10-CM coding standards • Strong understanding of coding rules and CMS guidelines in outpatient settings • Excellent organizational and interpersonal skills • Ability to work on multiple tasks, under pressure, meet deadlines, and provide excellent follow-up • Excellent oral and written communication skills • Ability to work effectively as a team member

🏖️ Benefits

• Comprehensive Total Rewards package supporting health, financial security, and career growth