-
PAREXEL St Paul, United StatesHome Based, US · As a Sr Quality Manager in Technology Quality Management (TQM) you will manage efforts to define, adopt and oversee compliance to processes and standards as the fundamental baseline for technology solution development, validation and delivery. You will support ef ...
-
Accounting Team Lead
3 days ago
North Heights Church St Paul, United StatesAccounting Lead · Title: Accounting Lead · Reports to: Senior Director of Finance and Administration · Minimum Qualifications: Four-year degree in accounting or related field or eight years of relevant experience · Employment Status: Non-Exempt Hourly · 3 Imperatives: · ...
-
Chief Financial Officer
6 days ago
Women Venture St Paul, United StatesAbout the Organization · WomenVenture (WV) is a 501(c)(3) nonprofit organization with a mission to empower women to achieve their · economic goals by building profitable and sustainable businesses that transform communities. We execute on · this mission through a four-pillared ...
-
Chief Financial Officer
1 week ago
Minnesota Council of Nonprofits St Paul, United StatesPosition Title: Chief Financial Officer (CFO) · Supervisor: Chief Operating Officer · Department: Finance · FLSA Status: Full time, exempt · Salary Range: · $125,000 – $140,000 · Location: Combination of remote and office based · Organizational Summary · WomenVenture is a 501(c ...
-
Senior Project Manager
3 weeks ago
McGough Construction St Paul, United States Regular, Full timeMcGough is a respected partner that brings six generations of experience to high profile, unique and complex construction projects. We take great pride in our people and their extraordinary expertise in planning, development, construction and facility management. McGough employee ...
-
Industrial Project Executive
1 week ago
McGough Construction St Paul, United StatesMcGough is a respected partner that brings five generations of experience to high profile, unique and complex construction projects. · We take great pride in our people and their extraordinary expertise in planning, development, construction and facility management. · McGough e ...
-
Program Manager
2 weeks ago
Minnetronix Medical St Paul, United StatesJob Summary: · The Program Manager (PM) will lead project teams to manage and meet customer expectations, with ultimate responsibility for on-time, on-budget product execution. · The PM is the day-to-day contact with customers to manage the customer's project. The PM also leads i ...
-
Events Specialist
1 week ago
Page Mechanical Group Inc St Paul, United StatesNational Grid Renewables is a leading North American renewable energy company based in Minneapolis, Minnesota, with satellite offices located in the regions where it develops, constructs, and operates renewable energy projects. As a farmer-friendly and community focused company, ...
-
Program Manager
4 weeks ago
Minnetronix Medical St Paul, United StatesJob Summary:The Program Manager (PM) will lead project teams to manage and meet customer expectations, with ultimate responsibility for on-time, on-budget product execution. · The PM is the day-to-day contact with customers to manage the customer's project. The PM also leads int ...
-
Annual Fund Manager
1 week ago
GIRL SCOUTS OF MINNESOTA AND WISCON St Paul, United StatesJob Details · Job Location · Saint Paul Service Center - Saint Paul, MN · Position Type · Full Time · Description · $60,000 to 70,000 · GSRV Has Excellent Benefits · Position Summary · The Annual Fund Manager plays an integral part of the development team by supporting and ...
-
AVP, COP Transformation Project Manager
6 days ago
Synchrony St Paul, United StatesJob Description: · Role Summary/Purpose: · The AVP, COP Transformation Project Manager is responsible for driving process and project management for the Client Oversight Program (COP) Transformation office. This crucial role will partner across the Client Oversight program as wel ...
-
Director Revenue Integrity
2 weeks ago
Fairview Health Services St Paul, United StatesOverview · The Director of Revenue Cycle provides leadership and accountability for operational excellence of one or more of the major functions within Revenue Cycle. The Director of Revenue Cycle will implement effective strategies to ensure the department and organization maxi ...
-
Director Revenue Integrity
3 weeks ago
Fairview Health Services St Paul, United StatesOverview: · The Director of Revenue Cycle provides leadership and accountability for operational excellence of one or more of the major functions within Revenue Cycle. The Director of Revenue Cycle will implement effective strategies to ensure the department and organization max ...
-
Director Revenue Integrity
3 weeks ago
Fairview Health Services St Paul, United StatesOverview: · The Director of Revenue Cycle provides leadership and accountability for operational excellence of one or more of the major functions within Revenue Cycle. The Director of Revenue Cycle will implement effective strategies to ensure the department and organization maxi ...
-
Actuarial Director
5 days ago
Securian Financial St Paul, United StatesPosition Summary: · This position will provide leadership to our Enterprise Risk Management Actuarial function.? This will include leading a dynamic and highly visible enterprise team as well as strategic leadership for actuarial financial risks for Securian. Responsibilities wil ...
-
Actuarial Director
1 week ago
Securian Financial St Paul, United StatesPosition Summary: · This position will provide leadership to our Enterprise Risk Management Actuarial function. This will include leading a dynamic and highly visible enterprise team as well as strategic leadership for actuarial financial risks for Securian. Responsibilities wil ...
-
Actuarial Director
4 days ago
Securian Financial St Paul, United StatesPosition Summary: · This position will provide leadership to our Enterprise Risk Management Actuarial function. This will include leading a dynamic and highly visible enterprise team as well as strategic leadership for actuarial financial risks for Securian. Responsibilities wil ...
-
VP Revenue Cycle
3 weeks ago
Fairview Health Services St Paul, United StatesOverview · The Vice President of Patient Access and Clearance Services is a key member of the Revenue Cycle senior and servant leadership team. The position is accountable for setting, measuring, monitoring and achieving leading practice system operating standards for front end ...
-
VP Revenue Cycle
3 weeks ago
Fairview Health Services St Paul, United StatesOverview: · The Vice President of Patient Access and Clearance Services is a key member of the Revenue Cycle senior and servant leadership team. The position is accountable for setting, measuring, monitoring and achieving leading practice system operating standards for front end ...
-
Finance & Admin Manager
1 week ago
University of Minnesota St Paul, United StatesApply for Job · Job ID · 361121 · Location · Twin Cities · Job Family · Finance · Full/Part Time · Full-Time · Regular/Temporary · Regular · Job Code · 9781BA · Employee Class · Acad Prof and Admin · Add to Favorite Jobs · Email this Job · About the Job · Position Over ...
Risk Adjustment Oversight Lead - St Paul, United States - UCare
Description
Work Location:
Work From Home
Position Description
As the Risk Adjustment Oversight Lead, you will be responsible to develop, enhance, communicate and lead UCare's Risk Adjustment Oversight Program.
UCare's Oversight Program is accountable to manage all facets of UCare's Risk Adjustment activities as it relates to data submissions to government agencies for risk adjustment payments based on diagnoses that are compliant with applicable laws, regulations and contractual requirements.
You will work with the Audit Director to ensure UCare has effective program elements such as:policies & procedures, training & education, risk assessment, audit & monitoring, responding to detected offenses, developing corrective action initiatives, and effective lines of communication with the Compliance Officer and Disclosure Program.
Develop, implement, maintain and document UCare's Risk Adjustment Oversight Program.Prepare and present presentations to the UCare Risk Adjustment Steering Committee. Lead and facilitate the Risk Adjustment Data Compliance Team meetings. Present at other committees, meetings, as needed.
Ensure communications across multiple departments and to UCare leadership are effective.
Ensure appropriate policies and procedures are in place and updated per UCare's policies.
This includes key process functions including provider record retrieval processes and working with other areas of the company, as necessary.
In partnership with Corporate Learning and Development, ensure adequate training and education is in place for employees and providers/coders.
Develop, lead and execute the audit and monitoring plans for UCare's risk adjustment payments as it pertains to UCare and key vendor processes, making necessary adjustments, as needed.
Audits and monitoring should be designed to ensure the accuracy and integrity of the data being submitted to regulatory agencies for risk adjustment payments to ensure they are based on diagnoses coding that are compliance with applicable laws, regulations and contract requirements.
Perform clinical validation reviews of medical records to ensure the accuracy of diagnostic coding and adequacy of clinical documentation. Perform validation of diagnosis data submitted by external vendors. Document and report out on findings.Provide timely responses to any Risk Adjustment event occurrences. Facilitate the corrective action plan process with the business and/or providers and manage issues as they arise.
Manage and facilitate risk adjustment data validation audits by government agencies or outside audit vendors.
Drive the maintenance of internal chart review guidelines to ensure the accuracy of diagnoses data captured and submitted to regulatory agencies.
Assess the need for provider education and assist in the development of educational materials related to compliant coding and risk adjustment practices.
Monitor and communicate changes related to Regulations, ICD-10-CM codes and the risk adjustment models.
Maintain and communicate knowledge of risk adjustment regulatory requirements and serve as an internal resource for departments in implementing coding and process changes needed to meet compliance.
Education
Bachelor's degree demonstrated experience may be considered in lieu of degree. Current and valid professional coding certification from an accredited institution.
Required Experience
Three years of progressive coding experience using ICD-9/ICD-10-CM, CPT and HCPCS. Three years of experience with risk adjustment coding (HCC).
At least one year of coding, billing and compliance experience across a broad range of specialties and working with Medicare coding requirements.
Experience in conducting audits and medical record reviews.Preferred Experience
Experience with Data Validation audits. Clinical coding experience. Certified Risk Adjustment Coder (CRC).
#J-18808-Ljbffr
