Karen Jensen

About Karen Jensen

I have 15 years of experience working with Medicare Advantage and ACA risk adjustment initiatives including prospective/retrospective chart reviews, coordinating government RADV audits, encounter data/RAPS submissions, team leadership, and provider education. I also provide oversight to the Special Investigations Unit (SIU) for fraud, waste and abuse initiatives.

Experience

1. Manager, Risk Adjustment Compliance & Siu

   Quartz Health Solutions

   Jun 2020 — Present

   Independently provides oversight, direction, development, problem resolution and leadership for the organization\'s Risk Adjustment and Special Investigative Unit initiatives. Establishes goals and objectives that support continuous risk score optimization, data integrity and the prevention, detection and correction of fraud, waste and abuse in all lines of business.Coordinate the retrospective chart review efforts to ensure accurate coding and risk score optimization. Direct SIU staff to perform audits and investigations related to fraud, waste and abuse in accordance with the Anti-Fraud Plan and related policies, procedures and manuals.Responsible for coordinating responses to the annual HHS RADV audits for the applicable Commercial products, the CMS Medicare Advantage RADV/Medicaid audits and various fraud, waste and abuse audits as selected.Develop education and training for internal and external parties on Risk Adjustment methodologies, coding, and fraud, waste and abuse.

Education

• University of Wisconsin-La Crosse

  Bachelor of Applied Science (B.A.Sc.), Finance/Emphasis Insurance

Skills

• Medicare
• Hipaa
• Health Insurance
• Healthcare Management
• Medical Coding
• Icd-10 Certified
• Hospitals
• Healthcare
• Privacy Compliance
• Medical Terminology
• Medical Compliance
• Icd-9
• Policy
• Auditing
• Healthcare Information Technology
• Process Improvement
• Medicare Risk Adjustment
• Employee Benefits