Analyzes healthcare data to assess patient risk scores and ensure accurate reimbursement calculations. Utilizes patient health factors, their likely use of health care services, and the costs of those services to calculate payment adjustments, forecast revenue impacts, and identify coding gaps. Reviews medical claims, encounter data, and electronic health records to ensure proper coding of diagnoses and accurate reporting to government healthcare programs. Prepares reports on risk adjustment performance and recommends strategies to optimize financial performance while maintaining regulatory co ...mpliance. Requires a bachelor's degree. Typically reports to a manager. Occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. Typically requires 2-4 years of related experience.More Show Less
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