Optimizing Risk Adjustment for Accurate Reimbursements & Compliance
In today’s healthcare landscape, accurate risk adjustment is critical for maximizing reimbursements, maintaining regulatory compliance, and ensuring clinics receive fair compensation for the complexity of their patient populations.
At Eleos Virtual Healthcare Solutions, our Risk Adjustment Specialists work alongside providers and clinical teams to assess patient risk, improve documentation accuracy, and enhance financial sustainability. By leveraging electronic health records (EHRs), risk adjustment software, and CMS compliance guidelines, our specialists help optimize reimbursements while maintaining the highest standards of documentation integrity.
What We Do
Our highly trained, bilingual Virtual Healthcare Associates (VHAs) ensure clinics capture accurate patient risk profiles, prevent revenue loss, and stay compliant with regulatory standards.
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Think of them as your clinic’s coding and compliance expert—ensuring accurate documentation, financial optimization, and regulatory adherence while improving overall patient care.
Key Responsibilities
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Chart Review & Coding Accuracy – Conduct detailed medical record reviews, ensuring that diagnoses accurately reflect patient conditions and risk factors.
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Risk Score Calculation & Analysis – Evaluate Risk Adjustment Factor (RAF) scores and identify potential impacts on reimbursements and financial sustainability.
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Provider Education & Collaboration – Partner with physicians to enhance understanding of risk adjustment coding and how it influences patient care, compliance, and revenue.
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Compliance Monitoring – Ensure full compliance with CMS, HHS, and regulatory standards by following risk adjustment and privacy guidelines.
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Data Validation & Submission – Validate risk adjustment data before submission to agencies like CMS, ensuring accuracy in diagnosis codes and supporting documentation.
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Quality Improvement & Reporting – Develop documentation improvement strategies to optimize risk scores and reduce coding discrepancies.
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Technology & EHR Utilization – Use risk adjustment software and EHR systems to analyze coding gaps, streamline documentation, and improve data accuracy.
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Auditing & Error Resolution – Conduct regular audits to ensure coding accuracy, resolve errors proactively, and maintain data integrity.
Why Your Clinic Needs a Virtual Risk Adjustment Specialist
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Optimize Reimbursements & Financial Sustainability – Ensure your clinic receives appropriate Medicare & Medicaid reimbursements based on accurate patient risk assessments.
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Improve Documentation Accuracy – Reduce coding errors and incomplete records that could impact risk scores and compliance.
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Fully Secure & Compliant – Our specialists operate through a HIPAA-compliant VPN with direct EMR access for seamless risk adjustment data entry.
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Real-Time Provider & Clinic Support – Collaborate with your team via Teams, Zoom, or integrated coding workflows.
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Reduce Audit Risks & Ensure Compliance – Stay ahead of CMS audits and regulatory changes with proactive monitoring and error resolution.
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Better Patient Outcomes & Quality Scores – Accurate risk assessment improves care planning, preventive care, and long-term patient health management.
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Bilingual, College-Educated Medical Doctors—Providing High-Quality Support at a Cost-Effective, All-Inclusive Rate Covering Taxes, Benefits, PTO, and More.
The Eleos Difference
At Eleos, our Risk Adjustment Specialists don’t just review charts—they protect your clinic’s financial health and compliance. By ensuring accurate coding, risk score optimization, and documentation integrity, we help providers reduce claim denials, prevent revenue loss, and deliver better patient care.
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Trained in your clinic’s specific workflows
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Dedicated to a specific provider or coding team
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Bilingual support available
Start transforming your clinic today—click HERE or call 1-844-MY-ELEOS!
