Job Title. Certified Risk Coder (CRC) – Risk Adjustment & Compliance. Position Summary. We are seeking. two experienced Certified Risk Coders (CRCs). to join our team and support risk-adjustment, coding quality, and compliance functions. In this role, you will perform accurate. HCC and ICD-10-CM coding. ensure compliance with. CMS V28 guidelines. conduct quality assurance (QA) audits, and help maintain regulatory and payer-specific standards. A c...
Job Title. Clinical Documentation Improvement (CDI) Specialist – International Medical Graduate (IMG). Position Summary. We are seeking. two highly motivated International Medical Graduates (IMGs). with a strong internal medicine background and familiarity with medical coding/documentation to join our. Clinical Documentation Improvement (CDI) team. In this role, you will review clinical charts, identify documentation gaps, collaborate with provid...
Job Title. Pharmacy Coordinator – Medicare Part D. Position Summary. We are seeking a detail-oriented. Pharmacy Coordinator. to support the daily operations of our Medicare Part D Prescription Drug Program. This role ensures compliance with CMS and NCQA requirements while managing claims adjudication, coverage determinations, call log reviews, grievances, and other compliance-related activities. You will collaborate with internal teams and PBM pa...
Job Title. Certified Risk Coder (CRC) – Risk Adjustment & Compliance. Position Summary. We are seeking. two experienced Certified Risk Coders (CRCs). to join our team and support risk-adjustment, coding quality, and compliance functions. In this role, you will perform accurate. HCC and ICD-10-CM coding. ensure compliance with. CMS V28 guidelines. conduct quality assurance (QA) audits, and help maintain regulatory and payer-specific standards. A c...
Job Title. Clinical Documentation Improvement (CDI) Specialist – International Medical Graduate (IMG). Position Summary. We are seeking. two highly motivated International Medical Graduates (IMGs). with a strong internal medicine background and familiarity with medical coding/documentation to join our. Clinical Documentation Improvement (CDI) team. In this role, you will review clinical charts, identify documentation gaps, collaborate with provid...
Job Title. Pharmacy Coordinator – Medicare Part D. Position Summary. We are seeking a detail-oriented. Pharmacy Coordinator. to support the daily operations of our Medicare Part D Prescription Drug Program. This role ensures compliance with CMS and NCQA requirements while managing claims adjudication, coverage determinations, call log reviews, grievances, and other compliance-related activities. You will collaborate with internal teams and PBM pa...
Job Title. Risk Adjustment Analyst. Position Summary. We are seeking a. highly analytical and detail-oriented Risk Adjustment Analyst. to support our organization’s. Medicare Advantage, ACO REACH, ACA, and other risk-based programs. This role is critical in. reporting, trend analysis, RAF analytics, and provider opportunity targeting. The ideal candidate understands. CMS risk-adjustment methodologies, coding impacts. and can turn data insights in...
Company Overview. CSTS Customer Service and Technology Solutions LLC is a leading third-party administrator specializing in the healthcare sector. Our mission is to transform the healthcare experience by providing exceptional administrative services, including claims processing, customer enrollment, and compliance with federal regulations. Summary. The practice of case management and disease management is a process that manages client wellness an...
