2 claims specialist jobs found

ConcertoCare Under the direction of the Manager of Clinical Documentation Improvement, the Data Integrity Specialist is responsible for reviewing and ensuring the accuracy, completeness, and compliance of risk adjustment coding for all internal claim submissions. This role plays a critical function in supporting organizational performance under value-based care contracts by conducting pre-claim, concurrent, and retrospective audits, identifying coding and documentation gaps, and driving continuous improvement in performance. The ideal candidate brings deep expertise in ICD-10-CM and CMS-HCC, HHS, and Medicaid risk adjustment methodologies and collaborates closely with Clinical Documentation Improvement (CDI) Specialists. RESPONSIBILITIES Ensure compliance with all applicable CMS Risk Adjustment Methodology rules and regulations related to coding and documentation guidelines for Risk Adjustment. Maintain a consistent review of daily production volume per day while...

The Opportunity: Tetra Tech is seeking an experienced Project Manager to provide oversight in support of the Puerto Rico Public Housing Administration's (PRPHA) Program Management Services for Permeant Works Program (FEMA). The Project Manager is responsible for the day-to-day management, coordination, monitoring, and execution of assigned projects. This role ensures that project activities, deliverables, schedules, budgets, and compliance requirements are effectively managed throughout planning, procurement, construction, and closeout phases. Why Tetra Tech: At Tetra Tech, we are Leading with Science to solve the world's most complex challenges. Our industry-leading experts in engineering and consulting are committed to driving positive change in communities around the world. For over 50 years, we have been at the forefront of innovation and sustainability. Today we stand as a market leader, offering cutting-edge solutions in water, environment, energy, and international...