Top 437 Risk adjustment Jobs in San Francisco, Ca

Risk Adjustment Compliance Specialist, Principal
Blue Shield of California —Oakland, CA
- $148,940 - $223,300 a year
- Full-time
- Hybrid work
- Background check
- Pass drug screening
- Office
- Work from home
1d
HEALTH CODER - HCC & RISK ADJUSTMENT
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $42.79 - $48.75 an hour
- Full-time
- Bachelor of Science
- Mid-level
- 3 years
Associate Vice President, Risk Adjustment
Altais Health Solutions —Oakland, CA
- $169,950 - $225,000 a year
- Full-time
- Background check
- 5 years
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
Risk Adjustment Coding Specialist II
Millennium Healthcare Management Serv LLC —San Francisco, CA
- $22 - $33 an hour
- Full-time
- Mid-level
- Training & development
Quick Apply
15h
PROVIDER DISPUTE RESOLUTION SPECIALIST
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $42.79 - $48.75 an hour
- Full-time
- 5 years
- HIPAA
- Research
- Health insurance
- Dental insurance
Medical Informatics Analyst, Consultant
Blue Shield of California —Oakland, CA
- $123,090 - $184,800 a year
- Full-time
- Hybrid work
- Background check
- 5 years
- Pass drug screening
- Work from home
MSO PHYSICIAN REVIEWER
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $285,229.20 - $332,260.00 a year
- Full-time
- Medicine
- 3 years
- Analysis skills
HEDIS Abstractor (NorCal Region)
Astrana Health, Inc. —San Francisco, CA
- $27 - $33 an hour
- Email
- Hybrid work
- LVN
- HIPAA
- Mid-level
Quick Apply
Enterprise Risk management Analyst (7204U) Ethics, Risk & Compliance Service #85328
University of California Berkeley —Berkeley, CA
- $82,800 - $100,000 a year
- Full-time
- Customer service
- Writing skills
- Research
Chief of Operations
Earth Island Institute —Berkeley, CA
- $181,795 a year
- Email
- Hybrid work
- 5 years
- Bachelor of Science
- Office
- 403(b) matching
- Paid holidays
Quick Apply
Board Certified Behavior Analyst (BCBA) - Oakland
KIPP Public Schools Northern California —Oakland, CA
- $106,000 - $125,895 a year
- Full-time
- School experience
- Classroom
- High school
- Commuter assistance
- Health insurance
Quick Apply
8d
Director of Procurement and Materials Management
AC Transit —Oakland, CA
- $196,106 - $234,164 a year
- Online Application
- Research
- Office
- Bachelor's degree
- Wellness program
- Commuter assistance
9d
Production Planner
CHawk Technology —Hayward, CA
- $75,000 - $85,000 a year
- Extended hours
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
9d
Building Commissioning Project Manager
CAI —San Francisco, CA
- $100,000 - $150,000 a year
- Full-time
- Hybrid work
- 5 years
- Analysis skills
- Continuous improvement
- Disability insurance
- Health insurance
Quick Apply
Workers’ Compensation Manager (Human Resources Manager)
AC Transit —Oakland, CA
- $156,059 - $186,365 a year
- Online Application
- Customer service
- Office
- 3 years
- Wellness program
- Commuter assistance
Senior Project Manager - Public Infrastructure
Cupertino Electric, Inc. —San Francisco Bay Area, CA
- $161,250 - $213,000 a year
- Full-time
- Microsoft Word
- Construction site
- Engineering
Financial Advisor
City National Bank —San Francisco, CA
- $95,000 a year
- Office
- Business development
- Bachelor's degree
- Health insurance
- Dental insurance
Operational Readiness Project Manager
CAI —San Francisco, CA
- $140,000 - $175,000 a year
- Overtime
- Hybrid work
- Bachelor of Science
- English
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
Senior Project Manager - Low-Voltage
Cupertino Electric, Inc. —San Francisco Bay Area, CA
- $161,250 - $213,000 a year
- Full-time
- Microsoft Word
- Construction site
- Engineering
Financial Advisor
City National Bank —Walnut Creek, CA
- $95,000 a year
- Office
- Business development
- Bachelor's degree
- Health insurance
- Dental insurance

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Risk Adjustment Compliance Specialist, Principal

Blue Shield of California -
Oakland, CA

Apply Now

Job Details

Full-time
$148,940 - $223,300 a year
1 day ago

Benefits

Work from home

Qualifications

Health data analysis
CMS
CMS regulatory compliance
Productivity software
Healthcare software applications
Healthcare data reporting

Full Job Description

Your Role

The Risk Adjustment Compliance Specialist, Principal is responsible for ensuring organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medicaid and Medicare Advantage lines of business. This role involves auditing, monitoring, and evaluating risk adjustment processes, identifying areas of non-compliance, and recommending corrective actions. The Principal collaborates with internal teams and external partners to maintain the integrity of risk adjustment data and supports the development and implementation of compliance programs.

Your Work

In this role, you will:

Conduct regular audits and reviews of risk adjustment data submissions to ensure compliance with regulatory requirements (e.g., CMS, OIG, HHS).
Monitor changes in risk adjustment guidelines, policies, and regulations, and communicate updates to relevant stakeholders.
Analyze risk adjustment processes and workflows to identify gaps, inefficiencies, or areas of non-compliance.
Prepare reports and presentations summarizing audit findings, compliance risks, and recommendations for improvement.
Collaborate with coding, clinical, and data management teams to ensure accurate and complete documentation for risk adjustment purposes.
Assist in the development and implementation of training programs related to risk adjustment compliance for staff and providers.
Support regulatory reporting and respond to compliance inquiries from internal and external auditors.
Maintain documentation of compliance activities and findings in accordance with organizational policies.
Participate in Risk Adjustment projects and initiatives, providing compliance expertise and guidance.
Strategic thought partner to ensure Risk Adjustment programs are in line with Blue Shield of California strategic goals.
Build strategic internal and external relationships that support the goals of the teams.
Participate in the development and execution of corrective action plans to address identified compliance issues.
Participates in the identification and assessment of potential compliance risks within risk adjustment processes and contributes to mitigation strategies.

Your Knowledge and Experience

Requires a college degree or equivalent experience. A degree in health care administration, business, public health, or related field is highly preferred
Requires a certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential
Requires 10 years of relevant experience in Risk Adjustment, Healthcare Compliance, Medical Coding, or related area
Requires strong knowledge of ICD-10-CM coding, HCC Risk Adjustment models (CMS-HCC and HHS-HCC), regulatory requirements, RADV audit documentation standards, and compliance standards
Requires experience with data analysis, auditing, and reporting in a healthcare environment
Requires excellent written and verbal communication skills, with the ability to convey complex information clearly
Requires one to be detail-oriented, analytical, and able to manage multiple priorities in a fast-paced setting
Requires proficiency in Microsoft Office Suite and relevant healthcare software applications
Experience with ACA Marketplace (HHS-HCC) and/or Medi-Cal/Medicaid Managed Care Risk Adjustment programs is highly preferred
Certification in Healthcare Compliance (CHC) is preferred
#LI-CS1

ABOUT THE TEAM
About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Apply Now

Refine Your Search

risk adjustment jobs in san francisco, ca

Risk Adjustment Compliance Specialist, Principal

HEALTH CODER - HCC & RISK ADJUSTMENT

Associate Vice President, Risk Adjustment

Risk Adjustment Coding Specialist II

PROVIDER DISPUTE RESOLUTION SPECIALIST

Medical Informatics Analyst, Consultant

MSO PHYSICIAN REVIEWER

HEDIS Abstractor (NorCal Region)

Enterprise Risk management Analyst (7204U) Ethics, Risk & Compliance Service #85328

Chief of Operations

Board Certified Behavior Analyst (BCBA) - Oakland

Director of Procurement and Materials Management

Production Planner

Building Commissioning Project Manager

Workers’ Compensation Manager (Human Resources Manager)

Senior Project Manager - Public Infrastructure

Financial Advisor

Operational Readiness Project Manager

Senior Project Manager - Low-Voltage

Financial Advisor

I want to receive the latest job alert for risk adjustment in san francisco, ca

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