risk adjustment manager

Baptist Health System KY & IN

<div><p><b>Summary
</b></p><p><b>Job Description:
</b></p><p><b><i>Baptist Health Medical Group is looking for an Ambulatory CDI Specialist to join our team! This is a remote work position that requires residency in KY or IN
</i></b></p><p></p><div><div><div><div><div><div><div><div><div><p>The BHMG Ambulatory CDI Specialist I is responsible for the evaluation of documentation utilizing their coding and clinical expertise to ensure specificity of coding and coding accuracy. They identify HCC diagnosis codes, ensure documentation accurately reflects the medical necessity and acuity of the patients. They provide guidance/education to the providers, medical assistants, practice managers and ancillary staff on clinical documentation best practices. Position requires a self-motivated, flexible, confident presenter that is able to travel and work remotely as well as attend internal meetings.
</p><p></p><p><b><i>Minimum Education, Training, and Experience Required
</i></b></p><ul><li><p>2 years&rsquo; professional medical group coding experience
</p></li><li><p>Experience with:
</p><ul><li><p>ICD-10-CM coding principles and procedures,
</p></li><li><p>HCPCS, CPT, CPT II and modifier coding,
</p></li><li><p>CMS HCC, HHS HCC, Rx HCC coding and risk adjustment assignment as it relates to provider documentation,
</p></li><li><p>Knowledge of Microsoft Office (Outlook, PowerPoint, Excel)
</p></li></ul></li></ul><ul><li><p><b><i>Preferred Experience
</i></b></p><ul><li><p>HCC (CMS, HHS, Rx HCC) coding and risk adjustment assignment as it relates to provider documentation,
</p></li><li><p>Proficient experience with Epic and/or other major EMR vendor software, and
</p></li><li><p>Presenting education to coders, providers and/or other caregivers.
</p></li><li><p><i>Clinical experience a plus
</i></p></li></ul></li></ul><p><b><i>Certification/Licenses:
</i></b></p><ul><li><p>Active Certification Required:
</p><ul><li><p>Certified Professional Coder (CPC)
</p><p>certification or Certified Coding Specialist-Physician based (CCS-P) or equivalent
</p><p>certification from AAPC, AHIMA or other
</p><p>acceptable professional organization.
</p></li></ul></li><li><p>A minimum of one additional advanced certification, required within one year of hire.
</p><ul><li><p>CRC = Certified Risk Adjustment Coder (certification)
</p></li></ul></li></ul></div></div></div></div></div></div></div></div></div><p><b>Work Experience
</b></p><p></p><p><b>Education
</b></p><h3 class="jobSectionHeader"><b><i>If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!
</i></b></h3><p></p><h3 class="jobSectionHeader"><b>Baptist Health is an </b><b><i>Equal Employment Opportunity </i></b><b>employer.</b></h3></div>

BHMG Ambulatory CDI Specialist

Advantmed

<div>
 <p>
  <strong>
   Nurse Practitioner (1099 / PRN) - In Home Assessments
  </strong>
 </p>
 <p>
  <strong>
   Pay
  </strong>
  {{:}} ~$100 per completed assessment + paid mileage
 </p>
 <p>
  <strong>
   Schedule
  </strong>
  {{:}} Flexible weekdays | No evenings, weekends, or on call
 </p>
 <p>
  <strong>
   Work Model
  </strong>
  {{:}} 1099 Independent Contractor (PRN)
 </p>
 <p>
  <em>
   Designed for NPs seeking reliable, ongoing PRN income with structure and support
  </em>
 </p>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   About the Role
  </strong>
 </p>
 <ul>
  <li>
   Advantmed is seeking a licensed, dependable Nurse Practitioner to conduct structured, in home wellness and risk adjustment assessments for Medicare members and other at-risk populations
  </li>
  <li>
   This PRN role offers flexibility with consistent visit availability and strong operational support. It is best suited for NPs who value autonomy, professionalism, and accountability and are looking for steady supplemental income, not short term or ad hoc work
  </li>
 </ul>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   Why Advantmed
  </strong>
 </p>
 <ul>
  <li>
   Partnering with 40+ health plans and supporting 1M+ providers nationwide
  </li>
  <li>
   99% Provider Satisfaction and 97% Member Satisfaction
  </li>
  <li>
   30%+ In Home Assessment completion rates, even in complex populations
  </li>
  <li>
   Clinically led, quality first organization with standardized visits and strong QA
  </li>
  <li>
   Technology enabled workflows and clear training from day one
  </li>
 </ul>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   Why You'll Like This Role
  </strong>
 </p>
 <ul>
  <li>
   Paid training and standardized onboarding
  </li>
  <li>
   ~$100 per completed visit + mileage
  </li>
  <li>
   Most providers complete 4-5 visits per day, based on availability
  </li>
  <li>
   Visits ready to schedule immediately
  </li>
  <li>
   Choose your own weekday availability
  </li>
  <li>
   Dedicated coordinators, scheduling, and tech support
  </li>
 </ul>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   What You'll Do
  </strong>
 </p>
 <ul>
  <li>
   Conduct in home Annual Wellness Visits and chronic condition assessments
  </li>
  <li>
   Perform focused histories, exams, vitals, medication reviews, and screenings
  </li>
  <li>
   Screenings{{:}} Hemoglobin A1C, Spirometry, KED (Kidney Health Evaluation), DRE (Diabetic Retinal Exam), FIT
  </li>
  <li>
   Educate members on preventive care and chronic disease management
  </li>
  <li>
   Document visits in the EMR to support value-based care and risk adjustment
  </li>
 </ul>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   All assessments are standardized, with training, equipment guidance, and EMR support provided.
  </strong>
 </p>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   Important Role Expectations
  </strong>
 </p>
 <ul>
  <li>
   This is a 1099 PRN role requiring consistency and reliability
  </li>
  <li>
   Maintain ongoing monthly availability
  </li>
  <li>
   Be responsive during onboarding and scheduling
  </li>
  <li>
   Honor confirmed visits and assignments
  </li>
  <li>
   Work independently and professionally in the field
   <br/>
  </li>
 </ul>
 <p>
  <strong>
   Minimum commitment{{:}}
  </strong>
  &nbsp;~30 hours per month, ongoing - Not intended for casual or very short-term engagement.
 </p>
 <p>
  <strong>
   Travel Expectations
  </strong>
  {{:}} Daily travel within a 55-mile radius of the assigned county
 </p>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   Qualifications
  </strong>
 </p>
 <ul>
  <li>
   Active, unencumbered NP license in the applicable state
  </li>
  <li>
   3+ years of patient care experience preferred
  </li>
  <li>
   Comfortable with EMR systems and independent work
  </li>
  <li>
   In home or risk adjustment experience preferred
  </li>
  <li>
   Willing to obtain additional licensure if needed (supported by Advantmed)
  </li>
 </ul>
 <p>
  &nbsp;
 </p>
 <p>
  <strong>
   What Advantmed Offers
  </strong>
 </p>
 <ul>
  <li>
   Competitive per visit compensation
  </li>
  <li>
   Paid mileage
  </li>
  <li>
   Flexible, provider driven scheduling
  </li>
  <li>
   Appointment confirmation and advanced member scheduling support
  </li>
  <li>
   Dedicated coordinator and clinical escalation support
  </li>
  <li>
   Modern, technology enabled documentation workflows
  </li>
 </ul>
</div>


Field Nurse Practitioner - Montgomery County, Ohio

North Middlesex Regional School District

<b>POSITION:</b> ADJUSTMENT COUNSELOR/ SOCIAL WORKER REPORTS TO: Building Principal, Director/Asst. Director of Special Education ESSENTIAL FUNCTIONS: Adjustment counselors/ Social Workers assist students with academic learning by providing strategic services that identify and address the social-emotional-environmental issues that interfere with the educational process. Working with parents/guardians, teachers, school principal/principal's designee, and community based resources, the school counselor/ adjustment counselor implements strategies that promote students' positive school adjustment. Adjustment counselors/ Social Workers are members of the Special Education Department.
<br><br>
Each adjustment counselor/ social worker is assigned to the school(s) based upon identified needs of the student population. JOB DUTIES: Identifies and assesses academic problems through analysis of factors impinging on student adjustment including factors in the home, school, and community. Determines and implements appropriate school based therapeutic strategies to effect changes in behavioral-social interactions of students and their families. Collection and documentation of student progress through progress monitoring and observation data.
<br><br>
Provides individual and group therapeutic counseling to students and, as appropriate, families. Collaborates with school staff and other school system personnel in implementing strategies to promote student learning. Participate as members of the IEP and other school based teams to develop interventions for promoting students' academic success. Serves on both school-based and system-wide committees to address educational, adjustment problems, safety issues, and program development for students.
<br><br>
Provides crisis intervention services. Completes psychosocial assessments to assist in the determination of special education services. Provides social work case management for students and families. Provides staff consultation on behavioral/emotional/environmental issues affecting student participation in the learning process.
<br><br>
Maintains required clinical records and submits appropriate documents for statistical reports with adherence to program standards in school social work. Serves as District Contact Person for related service IEPs, social/counseling goal. Manages a 504 caseload, including setting up parent meetings, writing 504 plans, and ensuring stakeholders are made aware of new and adjusted 504 plans. Completes risk assessments on referred students.
<br><br>
Serves as liaison with community agencies and assists in fostering communication between schools, parents/guardians, and community leaders. Locates and mobilizes community resources to support the educational program. Attends meetings and professional development activities as required. Follows all federal, state and district-wide mandates, laws, and initiatives.

Adjustment Counselor/ Social Worker

MAERSK

<p></p><div><p>Responsible for the accuracy and completeness of facility reporting a GP and EBIT level and generating clear understanding of product profitability in support of the finance business partners.
<br>
Accountable for month end and reporting of financial performance &amp; risk.<br>
</p><p><br>
<b>Specific Responsibilities:
</b></p><ul><li>Work with the general manager of site to ensure all revenue and costs are transacted in the finance system.
</li><li>Translation of operationally performed activities to financial figures.
</li><li>Be responsible for Month-end reporting, review and propose any adjustment needed to ensure arcuate job costing and monthly result.
</li><li>Ensure monthly risk assessment and control performances are 100% compliant
</li><li>Proactively review and mitigate key and critical risk areas.
</li><li>Minimize and control manual accruals, improving accuracy.
</li><li>Provide full customer and profit transparency with the Financial Business Partners, General Manager and Product Managers.
</li><li>Conduct and be responsible for internal audit processes, ensuring compliance to defined best practice and maintain our operational procedures.
</li><li>Provide forward-looking and independently initiated analysis on margins, trends and productivity.
</li></ul><p><b>Key skills for the role
</b></p><p><i>Technical skills:
</i></p><ul><li>Data mining / analysis
</li><li>MS Office, specifically advanced in Excel
</li><li>Advanced knowledge of S4Hana preferably including business warehouse or business intelligence as a plus
</li></ul><p><b><i>Qualifications &amp; Experience:
</i></b></p><ul><li>University degree in a related area.
</li><li>Preferred: SOCPA accreditation.
</li><li>Minimum 5 years of Finance experience .2+ years working in a financial reporting role
</li><li>Experience in Supply Chain Management and/or Logistics and Services products preferred.
</li><li>Excellent command of written and spoken English.
</li><li>Contract Logistics / warehouse experience preferred.
</li><li>Experience with financial processes and practices
</li><li>Strong analytical, planning, presentation, and organizational skills.
</li><li>Preferred, level of financial qualification.
</li></ul><p></p><p>Maersk is committed to a diverse and inclusive workplace, and we embrace different styles of thinking. Maersk is an equal opportunities employer and welcomes applicants without regard to race, colour, gender, sex, age, religion, creed, national origin, ancestry, citizenship, marital status, sexual orientation, physical or mental disability, medical condition, pregnancy or parental leave, veteran status, gender identity, genetic information, or any other characteristic protected by applicable law. We will consider qualified applicants with criminal histories in a manner consistent with all legal requirements.<br>
</p><p></p><p>We are happy to support your need for any adjustments during the application and hiring process. If you need special assistance or an accommodation to use our website, apply for a position, or to perform a job, please contact us by emailing accommodationrequests@maersk.com .</p></div><p></p>

Area Site BCO (KAP Site), SAA

Mac Care

<p><b>Job Summary</b></p><p>We are seeking a detail-oriented <b>Clinical Data Analyst</b> with strong expertise in healthcare analytics and hands-on experience working with <b>clinical research data</b>. This role will support our <b>Value-Based Care (VBC)</b> and <b>MSSP initiatives</b>, while also contributing to the analysis and interpretation of clinical datasets from research and quality improvement programs.</p><p>The ideal candidate will transform complex healthcare and clinical research data into actionable insights to improve patient outcomes, ensure regulatory compliance, and drive data-informed decision-making.</p><p><b>Key Responsibilities</b></p><ul><li>Analyze and manage <b>CCLF, HCC, and quality data</b> for MSSP and Value-Based Care programs.</li><li>Work with <b>clinical research datasets</b> (e.g., study data, patient cohorts, outcomes data) to support research analysis and reporting.</li><li>Develop and maintain <b>interactive dashboards</b> using Power BI to track performance, clinical outcomes, and quality metrics.</li><li>Perform <b>data extraction, transformation, and cleaning</b> using Power Query and SQL.</li><li>Collaborate with <b>clinical, research, and operations teams</b> to identify high-risk populations and monitor quality measures.</li><li>Support <b>CMS reporting</b>, risk adjustment analysis, and quality improvement initiatives.</li><li>Assist in <b>clinical study data validation, reconciliation, and audit readiness</b>.</li><li>Ensure data integrity, accuracy, and compliance with <b>healthcare regulations (HIPAA, CMS guidelines)</b>.</li><li>Translate complex datasets into <b>clear insights and recommendations</b> for leadership and stakeholders.</li></ul><p><b>Requirements</b></p><ul><li>Bachelor&rsquo;s degree in <b>Computer Science, Data Analytics, Public Health, Biostatistics</b>, or a related field.</li><li><b>2&ndash;4 years of experience</b> in healthcare data analytics, <b>clinical research data analysis</b>, or value-based care programs.</li><li>Hands-on experience working with <b>clinical datasets, research data, or population health data</b>.</li></ul><p><b>Technical Skills</b></p><ul><li>Power BI (2+ years) &ndash; dashboarding and visualization</li><li>Power Query (2&ndash;3 years) &ndash; data transformation</li><li>SQL &ndash; data extraction and manipulation</li><li>Strong skills in <b>data cleaning, validation, and analysis</b></li></ul><p><b>Domain Knowledge</b></p><ul><li>Understanding of <b>CMS programs, MSSP, and HCC risk adjustment</b></li><li>Familiarity with <b>clinical research processes, datasets, and reporting standards</b></li><li>Experience with <b>EMR/EHR systems and population health tools</b></li></ul><p><b>Preferred Qualifications</b></p><ul><li>Experience supporting <b>clinical trials, registry data, or outcomes-based research</b></li><li>Knowledge of <b>study design, cohort analysis, and healthcare quality measures (e.g., HEDIS)</b></li><li>Exposure to <b>statistical tools (R, Python, or similar)</b> is a plus</li></ul><p>Job Type: Full-time</p><p>Work Location: In person</p>

Clinical Data Analyst

Marriott International

<div><b>Additional Information</b><br>
<b>Job Number</b>26056861<br>
<b>Job Category</b>Finance &amp; Accounting<br>
<b>Location</b>Marriott International HQ, 7750 Wisconsin Ave, Bethesda, Maryland, United States, 20814<br>
<b>Schedule</b>Full Time<br>
<b>Located Remotely?</b>N<br>
<b>Position Type</b> Management<br>
<b>Pay Range:</b> $96,000-$151,900 annually<br>
<b>Bonus Eligible:</b> Y
<p></p><div><div><div><p><b>JOB SUMMARY</b></p></div><br>
<p></p><div><p>The Claims Unit Manager is responsible for overseeing the adjustment and resolution of self-insured and self-administered casualty claims across multiple jurisdictions, ensuring compliance with legal and organizational standards. This role manages a team of 3&ndash;6 claims professionals, including adjusters, assistants, and administrative support personnel, providing training, guidance, and performance oversight. The manager monitors caseloads to maintain appropriate balance based on jurisdictional requirements and the complexity of workers&rsquo; compensation and general liability claims, ensuring high-quality, timely, and cost-effective claim outcomes.</p></div><br>
<p></p><div><p><b>CANDIDATE PROFILE</b></p><br>
</div><p></p><div><p><b>Education and Experience
</b></p></div><div><p><i>Required</i></p>
</div><div><ul><li>Minimum of 5 years claims adjusting experience with advanced knowledge of claims processing.</li>
</ul></div><div><ul><li>Demonstrated experience providing technical guidance and direction, including litigation case management training and support.</li>
</ul></div><div><ul><li>Strong technical knowledge of civil laws and state workers&rsquo; compensation statutes.</li>
</ul></div><div><p><i>Preferred</i></p>
</div><div><ul><li>Bachelor&rsquo;s degree in risk management or claims
</li></ul></div><div><ul><li>Certification from various Claims seminars</li></ul><br>
</div><p></p><div><p><b>CORE WORK ACTIVITIES</b></p>
<div><ul><li>Maintain primary responsibility for settlement decisions up to individual authority.</li>
</ul></div><div><ul><li>Assign, control and monitor staff investigations/dispositions to assure compliance with state laws/regulations and department policies and procedures.</li>
</ul></div><div><ul><li>Monitor and approve benefit, claims and expense payments to assure reasonableness, accuracy and timeliness.</li>
</ul></div><div><ul><li>Review unit transactions to assure proper procedure and prompt error corrections.</li>
</ul></div><div><ul><li>Oversee and manage unit Service Call Program.</li>
</ul></div><div><ul><li>Monitor and assess adequacy of reserves.</li>
</ul></div><div><ul><li>Oversee and ensure the effective management of workers' compensation (WC) and liability claims by adjusters, in accordance with legal requirements and company policies. Key areas of focus include but are not limited to:</li>
</ul></div><div><ul><li>Prompt investigation of claims, including obtaining statements to determine liability and compensability.</li>
</ul></div><div><ul><li>Evaluation of damages and payment of benefits as prescribed by law and/or Marriott policies and procedures.</li>
</ul></div><div><ul><li>Collection of necessary documentation to support timely loss adjustment and oversight of settlement decisions within individual authority limits.</li>
</ul></div><div><ul><li>Completion and monitoring of timely WC payments and required state filings.</li>
</ul></div><div><ul><li>Management of WC medical treatment with the goal of minimizing disability, including consultation with Occupational Health Services as needed.</li>
</ul></div><div><ul><li>Oversight of litigation cases, including coordination with outside attorneys and support for discovery, trial preparation, and legal strategy.</li>
</ul></div><div><ul><li>Evaluation of claims for potential third-party liability or subrogation recovery.</li>
</ul></div><div><ul><li>Partner with the Regional Director and Operations Managers to ensure effective communication, coordination, and issue resolution across key operational areas, including:</li>
</ul></div><div><ul><li>Notifying leadership of staff absences, schedules, and appointments.</li>
</ul></div><div><ul><li>Informing of attorney, vendor, or other visits from external parties.</li>
</ul></div><div><ul><li>Communicating updates on upcoming trials and their outcomes.</li>
</ul></div><div><ul><li>Evaluating significant and high-risk incidents.</li>
</ul></div></div></div><div><div><ul><li>Reporting personnel issues or concerns as they arise.</li>
</ul></div><div><ul><li>Delivering monthly statistical reports within five days of receiving the data.</li></ul></div></div><p><br>
</p><p></p><p><i>Marriott International is an equal opportunity employer. We believe in hiring a diverse workforce and sustaining an inclusive, people-first culture. We are committed to non-discrimination on any protected basis, such as disability and veteran status, or any other basis covered under applicable law.</i></p><p></p><div>
All positions offer a 401(k) plan, stock purchase plan, discounts at Marriott properties, commuter benefits, employee assistance plan, and childcare discounts. Benefits are subject to terms and conditions, which may include rules regarding eligibility, enrollment, waiting period, contribution, benefit limits, election changes, benefit exclusions, and others. Click here to learn more.</div><div><br>
<br>
</div><div>Full-time positions also offer coverage for medical, dental, vision, health care flexible spending account, dependent care flexible spending account, life insurance, disability insurance, accident insurance, adoption expense reimbursements, paid parental leave and educational assistance.</div><div><br>
<br>
</div><div><b>Washington Applicants Only</b>: Employees will accrue paid sick leave, 0.077 PTO balance for every hour worked and be eligible to receive a minimum of 9 holidays annually.</div><div><br>
<br>
</div><div>Marriott HQ is committed to a hybrid work environment that enables associates to Be connected. Headquarters-based positions are considered hybrid, for candidates within a commuting distance to Bethesda, MD; candidates outside of commuting distance to Bethesda, MD will be considered for Remote positions.</div><p></p><p>
Marriott International is the world&rsquo;s largest hotel company, with more brands, more hotels and more opportunities for associates to grow and succeed. <b>Be</b> where you can do your best work, <b>begin</b> your purpose, <b>belong</b> to an amazing global team, and <b>become</b> the best version of you.</p></div></div>

Claims Unit Manager

<p>Job Summary</p><p>We are seeking a detail-oriented <b>Clinical Data Analyst</b> with strong expertise in healthcare analytics, hands-on experience working with clinical research data, and practical experience using <b>Athena EMR/EHR systems</b>. This role will support our Value-Based Care (VBC) and MSSP initiatives, while also contributing to the analysis and interpretation of clinical datasets from research and quality improvement programs.</p><p>The ideal candidate will transform complex healthcare and clinical research data into actionable insights to improve patient outcomes, ensure regulatory compliance, and drive data-informed decision-making.</p><p>Key Responsibilities</p><ul><li>Analyze and manage CCLF, HCC, and quality data for MSSP and Value-Based Care programs.</li><li>Work with clinical research datasets (e.g., study data, patient cohorts, outcomes data) to support research analysis and reporting.</li><li>Extract, validate, and analyze patient and operational data from <b>Athena EMR</b> and other healthcare systems.</li><li>Develop and maintain interactive dashboards using Power BI to track performance, clinical outcomes, and quality metrics.</li><li>Perform data extraction, transformation, and cleaning using Power Query and SQL.</li><li>Collaborate with clinical, research, and operations teams to identify high-risk populations and monitor quality measures.</li><li>Support CMS reporting, risk adjustment analysis, and quality improvement initiatives.</li><li>Assist in clinical study data validation, reconciliation, and audit readiness.</li><li>Ensure data integrity, accuracy, and compliance with healthcare regulations (HIPAA, CMS guidelines).</li><li>Translate complex datasets into clear insights and recommendations for leadership and stakeholders.</li></ul><p>Requirements</p><ul><li>Bachelor&rsquo;s degree in Computer Science, Data Analytics, Public Health, Biostatistics, or a related field.</li><li>2&ndash;4 years of experience in healthcare data analytics, clinical research data analysis, or value-based care programs.</li><li>Hands-on experience working with clinical datasets, research data, or population health data.</li><li>Experience working with <b>Athena EMR/EHR</b> systems for reporting, patient data extraction, workflow analysis, or operational support.</li></ul><p>Technical Skills</p><ul><li><b>Power BI (2+ years)</b> &ndash; dashboarding and visualization</li><li><b>Power Query (2&ndash;3 years)</b> &ndash; data transformation</li><li><b>SQL</b> &ndash; data extraction and manipulation</li><li>Experience navigating and reporting from <b>Athena EMR</b></li><li>Strong skills in data cleaning, validation, and analysis</li></ul><p>Domain Knowledge</p><ul><li>Understanding of CMS programs, MSSP, and HCC risk adjustment</li><li>Familiarity with clinical research processes, datasets, and reporting standards</li><li>Experience with EMR/EHR systems, especially <b>Athenahealth / Athena EMR</b>, and population health tools</li></ul><p>Preferred Qualifications</p><ul><li>Experience supporting clinical trials, registry data, or outcomes-based research</li><li>Knowledge of study design, cohort analysis, and healthcare quality measures (e.g., HEDIS)</li><li>Exposure to statistical tools such as R or Python is a plus</li></ul><p>Job Type: Full-time</p><p>Work Location: In person</p>

Clinical Data Analyst (Athena Experience Required)

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