Top 472 Risk adjustment Jobs in Houston, Tx

Risk Adjustment Coder II
Harris Health —Houston, TX
- $27.69 - $34.62 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Management
- Health insurance
- Dental insurance
Compliance Advisor - Analytics & Innovation
bp —Houston, TX
- $115,000 - $150,000 a year
- Full-time
- Hybrid work
- Pass drug screening
- Mid-level
- Analysis skills
- Paid parental leave
- Paid holidays
3d
Bilingual Medical Social Worker
Oak Street Health —Pasadena, TX
- $51,256 - $111,351 a year
- Full-time
- Master of Social Work
- Adults
- Mid-level
- Health insurance
- Dental insurance
Lighting Quotations Specialist
LED Inspirations —Houston, TX
- $60,000 - $65,000 a year
- Full-time
- Basic math
- Mid-level
- Continuous improvement
- Health savings account
- Paid holidays
Quick Apply
9d
HPC Architecture Leader
Viridien —Houston, TX
- Full-time
- Computer Science
- 8 years
- Mentoring
3d
Senior Engineer - Rotating Equipment
Calpine Operating Services Company —Pasadena, TX
- $109,779 - $139,969 a year
- Email
- 5 years
- Engineering
- Office
10d
Registered Dietitian RD - Home Infusion
HealthQuest Therapeutics LLC —Houston, TX
- From $73,000 a year
- Full-time
- 5 years
- Mid-level
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
Site Operations Manager
Viridien —Houston, TX
- Full-time
- Customer service
- 5 years
- Office
IPA, Network Provider Specialist [HOUSTON]
Nutex Holdco LLC —Houston, TX
- Full-time
- Microsoft Word
- Microsoft Access
- Marketing
- Health insurance
- Dental insurance
Quick Apply
Valuation Control, Senior Manager
Macquarie Group Limited —Houston, TX
- Full-time
- 11+ years
- Office
- Continuous improvement
- Paid parental leave
- Health savings account
13d
Digitalization Engineer - Gas Turbines
GenSystems Power Solutions —Houston, TX
- Full-time
- Mid-level
- Master's degree
- In-person
Quick Apply
Accounting Manager - Construction Accounting
Confidential —Houston, TX
- $100,000 - $130,000 a year
- Full-time
- Background check
- Research
- Finance
- Disability insurance
- Health insurance
Quick Apply
2d
Risk Adjustment Coding Specialist II - Houston
Astrana Health, Inc. —Houston, TX
- $66,000 - $78,000 a year
- Email
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Public speaking
Quick Apply
High School Advisory Teacher - Texas Connections Academy
Connections Academy —Houston, TX
- Full-time
- Remote
- High school
- Research
- Mid-level
IT Application Specialist
Fracht USA —Houston, TX
- Full-time
- Spanish
- Analysis skills
- Continuous improvement
Timekeeper
G2 Secure Staff, LLC —Houston, TX
- $22 an hour
- Weekends as needed
- 18 years or older
- English
- Administrative experience
3d
Workplace Health and Safety Specialist, Early Career – (2027) – West
Amazon.com Services LLC —Houston, TX
- $27.98 - $33.41 an hour
- Weekends as needed
- Data analysis skills
- Ability to climb stairs
- Master's degree
- AD&D insurance
- Health insurance
11d
Timekeeper
Menzies Aviation —Houston, TX
- $22 an hour
- Weekends as needed
- 18 years or older
- English
- Administrative experience
3d
Head of Ethics and Compliance, North America
ALS —Houston, TX
- Online Application
- Finance
- 8 years
- Project management
- Disability insurance
- Health insurance
Director of Mental Health Services
Covenant House Texas —Houston, TX
- $90,000 - $100,000 a year
- Full-time
- LMFT
- Licensed Clinical Social Worker
- LPC
- Health insurance
- Retirement plan
Quick Apply

I want to receive the latest job alert for risk adjustment in houston, tx

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

risk adjustment jobs near houston, tx

Risk Adjustment Coder II

Harris Health -
Houston, TX

Apply Now

Job Details

Full-time
$27.69 - $34.62 an hour

Benefits

Health insurance
Dental insurance
Vision insurance
Prescription drug insurance

Qualifications

Microsoft Excel
Microsoft Outlook
Management
Inpatient experience
Medicare
Managed care
Health information process improvement
Data validation techniques
Process optimization
Managed care organization experience
Data quality assurance
CMS
Mid-level
3 years
Medical coding experience in outpatient clinics
Certified Professional Coder
Medicaid health insurance
CMS regulatory compliance
Quality assurance audits
Analysis skills
Medicare regulations
Team training
Certified Coding Specialist
Health record chart audits
Organizational skills
Microsoft Teams
Centers for Medicare & Medicaid Services (CMS) billing regulations
Document quality checks
Medicaid regulations
Medicaid

Full Job Description

Job Details

Career area

CHC Administrative

Position Type

Full Time

Pay

$27.69 - $34.62

Location

CHC Loop Central - Remote, Houston, TX 77081, United States

Job ID

180041

Facebook
X
LinkedIn
Email

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

JOB SUMMARY
The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a subject matter expert for risk adjustment and will assist in the development of team trainings, quality assurance audits, and collaborating with multiple departments across the organization.

JOB SPECIFICATIONS AND CORE COMPETENCIES
Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions, utilizing ICD-10 coding guidelines for Commercial and Medicare risk adjustment programs.
Conduct thorough clinical documentation review to ensure sufficient support and management for coded conditions.
Identify opportunities to improve documentation and coding accuracy; provide analysis and recommendations for improvement to leadership
Consistently meet productivity and quality standards as outlined by supervisor.
Ensure coding compliance by following the Official Coding Guidelines, HHS-RADV Protocols, and attending REGTAP calls.
Stay current with coding standards, risk adjustment methodologies, and CMS Regulatory changes to ensure ongoing compliance and optimal coding practices.
Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans, and other duties as assigned.

QUALIFICATIONS: Education/Specialized Training/Licensure:

Bachelor's Degree or 5 or more years of experience in risk adjustment in lieu of degree in managed care organization required.

AHIMA/AAPC Certified Coder, Medical Billing and Coding certification required (CPC, CRC, COC, CCS, CCS-P, or any combination of listed certifications) required.

Associate or bachelor's degree preferred

Work Experience (Years and Area):

3-5 years' experience in Commercial or Medicare risk adjustment coding required.

Clinical documentation improvement experience for inpatient and outpatient preferred.

Experience within a managed care organization preferred.

Some management experience preferred

Software Proficiencies: Microsoft 365 (Word, Excel, Outlook, Point, Teams)

Other:
Strong analytical skills
Strong written and verbal skills
Strong interpersonal skills Solid knowledge of ACA,
Medicaid, and Medicare Risk Adjustment

Apply Now

Refine Your Search

risk adjustment jobs in houston, tx

Risk Adjustment Coder II

Compliance Advisor - Analytics & Innovation

Bilingual Medical Social Worker

Lighting Quotations Specialist

HPC Architecture Leader

Senior Engineer - Rotating Equipment

Registered Dietitian RD - Home Infusion

Site Operations Manager

IPA, Network Provider Specialist [HOUSTON]

Valuation Control, Senior Manager

Digitalization Engineer - Gas Turbines

Accounting Manager - Construction Accounting

Risk Adjustment Coding Specialist II - Houston

High School Advisory Teacher - Texas Connections Academy

IT Application Specialist

Timekeeper

Workplace Health and Safety Specialist, Early Career – (2027) – West

Timekeeper

Head of Ethics and Compliance, North America

Director of Mental Health Services

I want to receive the latest job alert for risk adjustment in houston, tx

Related Searches

Explore jobs in more locations

Job Details

Job Seeker Tools

Employer Tools

Browse

Stay Connected