Medicare Risk Adjustment Coder

Virtual Vocations Inc; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

Virtual Vocations Inc is seeking a full-time remote Provider Educator & Medicare Risk Adjustment Coder to support quality improvement initiatives by monitoring Medicare Stars data, conducting medical record reviews, and preparing compliance documentation.

Key responsibilities include coordinating HEDIS and Star data collection, data entry and review per NCQA and CMS specifications, and identifying opportunities for improvement to support program initiatives.

Qualifications

• Bachelor's degree in a job-related field or equivalent work experience.
• Professional certification in nursing, pharmacy, medical assistant, or related healthcare training.
• Minimum 2 years of experience in managed care, quality improvement, or clinical settings.
• Experience working with HEDIS standards and Medicare Advantage.
• Familiarity with clinical terminology and medical records.

Responsibilities

• Coordinates HEDIS and Star measure data collection using various resources.
• Conducts data entry and review of Star measure data per NCQA and CMS specifications.
• Identifies opportunities for improvement based on Stars data to support program initiatives.

Skills

HEDIS standards knowledge

Quality improvement

Medicare Advantage familiarity

Clinical terminology

Education

Bachelor's degree or equivalent

Professional certification in nursing, pharmacy, medical assistant, or related healthcare training

Job description

To support quality improvement initiatives, the full-time remote Provider Educator & Medicare Risk Adjustment Coder will monitor and collect Medicare Stars data, conduct medical record reviews, analyze findings, and prepare compliance documentation.

Key responsibilities

• Coordinates HEDIS and Star measure data collection using various resources
• Conducts data entry and review of Star measure data per NCQA and CMS specifications
• Identifies opportunities for improvement based on Stars data to support program initiatives

Required qualifications

• Bachelor's degree in a job-related field or equivalent work experience
• Professional certification in nursing, pharmacy, medical assistant, or related healthcare training
• Minimum 2 years of experience in managed care, quality improvement, or clinical settings
• Experience working with HEDIS standards and Medicare Advantage
• Familiarity with clinical terminology and medical records