Empowering independent physicians to practice medicine and impact the health of their communities how they've dreamed
Medicare Risk Adjustment Specialist I
Location
Massachusetts
Posted
2 days ago
Salary
$25 - $28 / hour
Seniority
Mid Level
Job Description
Medicare Risk Adjustment Specialist I
On Belay Health Solutions
• Review and validate AI-identified risk adjustment coding opportunities within medical records • Assess clinical documentation to determine the appropriateness of proposed diagnoses and HCC submissions • Support the quality assurance process for AI-assisted chart reviews by identifying coding discrepancies, false positives, and missed opportunities • Develop feedback loop with On Belay’s Head of Risk Adjustment Coding and physician offices On Belay supports, including but not limited to: Identification of quality improvement opportunities in individual physician coding • Any other related duties assigned at manager’s discretion
Job Requirements
- High school diploma or GED required
- Associates degree preferred
- Active coding certificate required
- AAPC or AHIMA coding certification preferred
- Required: CCS-P (Certified Coding Specialist- Physicianbased) or CPC (Certified Professional Coder)
- Preferred: CRC (Certified Risk Adjustment Coder)
- Experience in a primary care setting highly preferred
- Knowledge of medical terminology and medical chart review required
- Two (2) or more years’ experience of hierarchical condition categories (HCC)
- Knowledge of ICD-10-CM Official Guidelines for Coding and Reporting
- Knowledge of AHA Coding Clinic and authoritative coding resources
- Knowledge of Microsoft Office suite, primarily Excel (specifically Pivot Tables, sort and filter functions)
- Strong time management skills required
- Ability to navigate within various EMRs (Electronic Medical Records), Cerner Preferred
- Strong interpersonal, communication (verbal, non-verbal and listening) skills
- Ability to remain productive under time constraints and meet deadlines critical to the business.
Benefits
- Innovative, revolutionary environment
- Great culture with a strong sense of mission and community
- Eleven (11) Paid Holidays
- Lavish PTO accrual
- Advancement opportunities & professional skills training
- Strong referral bonus program
- And more!
Related Guides
Related Categories
Related Job Pages
More Risk Jobs
• Support management of the global legal entity structure, including formations, dissolutions, and governance records • Prepare proxies, annual meeting minutes, and written consents/resolutions for subsidiaries and affiliates • Coordinate approval and execution of corporate documents, including annual accounts and written consents and resolutions, across jurisdiction • Maintain corporate records, including officer and director appointments • Serve as a point of contact for Legal, Tax, Controllership, and Treasury on entity governance matters • Assist Business Development with information and documentation related to acquisitions and divestitures • Provide corporate entity information and required documentation regarding the Legal Entity Reduction projects for US and Canadian entities • Administer the Global Entity Management System (GEMS), including maintaining accurate legal entity data • Coordinate quarterly GEMS certification process and related outreach • Prepare certification materials and supporting documentation for SOX compliance and external audit requirements • Partner with Controllership and Internal Audit to support internal controls related to governance data • Support Treasury with KYC and related regulatory and banking requests • Prepare corporate documentation and certifications for banking, financing, and compliance purposes • Respond to internal and external requests for entity information, providing reports related to information in GEMS, including officer and director listings, ownership information, etc. • Assist with managing the Corporate Governance and Board calendars, including tracking key deliverables, deadlines, and recurring governance activities • Work cross-functionally to prepare for and organize Board meetings, annual general meetings, and other Board events • Support SEC filing logistics, including signature coordination, Section 16 form preparation, and proxy statement/annual meeting preparation • Administer insider trading windows and pre-clearance trading requests, consistent with Carrier’s Insider Trading Policy • Coordinate communications with Board members, including distribution of materials and matters relating to director compensation • Maintain organized and up-to-date records for all Board matters, including Board and Committee minutes, agendas, materials, and communications
• Support the general liability claims process • Help claims examiners conduct timely investigations and preserve evidence • Set up claims with the third-party administrator (TPA) • Ensure examiners have complete and accurate information for investigations • Manage the general mailbox and route claim materials to files and examiners • Download, validate, and preserve surveillance and dashcam footage • Review potential third-party exposure and support landlord/vendor tenders • Coordinate gift card activation requests and communicate status to examiners
• Manages mid-size projects or significant segments of very large projects with limited supervision • Acts as a consultant to the business lines • Prepares management reports to summarize the status of projects and work activities • Initiates project evaluation effectiveness post-implementation • Ensures compliance to policies and procedures
Risk Manager
KafeneWe offer a flexible and affordable form of consumer financing that helps retailers serve a wider segment of customers.
• Leverage multiple and complex data sources such as Bureau information, alternative data, consumer behavior, the macro environment, and portfolio performance metrics to perform quantitative analyses, classification/decision-tree analyses and/or machine learning modeling to understand root causes and/or potential business opportunities. • Translate data into meaningful insights, and design, implement and iterate on strategies to drive profitable business growth. Review findings with senior management, like CRO and CEO. • Design and manage A/B tests, pilot programs, and controlled experiments to evaluate new strategies, including defining test populations, randomization logic, and success criteria. • Build and maintain dashboards and reporting infrastructure to enable real-time monitoring of strategy performance across key metrics. • Monitor our acquisition and portfolio performance related to consumer or merchant credit risk, fraud risk, lease amount, term, channel, and other important metrics across the account lifecycle. • Monitor both internal and macroeconomic performance to define risk appetite and ensure healthy businesses under different environments. • Partner with technology, product, and cross-functional teams to ensure timely and quality implementation with diligent test validation. Track the performance to ensure that it meets expectations.




