- UnitedHealth Group (San Antonio, TX)
- …analytical background within Medicare Advantage or government programs ( Risk Adjustment /STARS Calculation models) Previous experience in provider-facing ... with providers in various care delivery models) Solid knowledge of the Medicare market, products and competitors Knowledge base of clinical standards of care,… more
- Clever Care Health Plan (Huntington Beach, CA)
- …for assisting with the deployment and implementation of various Stars and Risk adjustment programs tied to medical records retrieval strategies, collecting ... will also be involved with continuous training and education on HEDIS, Stars and Risk Adjustment measures to close gaps in care. Functions & Job Responsibilities… more
- Knox Community Hospital (Mount Vernon, OH)
- …preferred 3 years' experience in physician office setting required Experience in Risk Adjustment and quality measures ie (Hedis/Stars, eCQM's, PCMH) Knowledge ... System ( MIPS ) and alternative payment models offered by Centers for Medicare and Medicaid Services (CMS) and patient centered medical home models. Ability to… more
- CareFirst (Baltimore, MD)
- …leadership roles. + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial ... the organization in making better business decisions. The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. + Analyze… more
- Elevance Health (Grand Prairie, TX)
- ** Medicare Risk Adjustment Advanced Analyst Senior** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration ... dynamic and adaptable workplace. Alternate locations may be considered. The ** Medicare Risk Adjustment Advanced Analyst Senior** is responsible for creating… more
- BlueCross BlueShield of North Carolina (NC)
- …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + ... The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous health and… more
- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... Serve as a key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: $78,500 -… more
- TEKsystems (Sunrise, FL)
- …- Provide support for the Quality Department to perform improvement and review procedures. - Conduct internal record reviews and audits, including medical records. - ... Review records to ensure they are complete, accurate and compliant with standards Initiate SOP revisions to ensure they are current and validated and support continuous improvement - Develop and enhance documentation, tracking tools and process flows for… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …Graduate. Certified coder CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment / Medicare Advantage and/or clinical. Plans ... and supporting clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. Medicare and...Risk Adjustment Data Validation (RADV) Timelines. Medicare and Medicaid regulations and billing guidelines and AMA's… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent the Risk … more
- The Cigna Group (Houston, TX)
- …experience with medical claims data (CPT/ICD10) + Experience with HHS ACA (or Medicare ) risk adjustment models; Healthcare Actuarial Modeling or financial ... join the IFP Analytics team responsible for identifying and sizing new risk adjustment opportunities that not only create better health outcomes for patients but… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk ... Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance,… more
- Highmark Health (Blue Bell, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Development and Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs… more
- Hartford HealthCare (Hartford, CT)
- …in a variety of settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds relationships, programs, and processes ... recognition programs and other common practices across the system. *JOB SUMMARY:* The Risk Adjustment Coder Educator develops and implements an enterprise-wide … more
- Providence (Portland, OR)
- …related field is preferred. + **Experience:** At least 7 years of experience with Medicare , Medicaid, and Commercial risk adjustment processes, plus 5 years ... in the states of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you will be the cornerstone of… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and vendor performance relative to established contracts. * Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply broad actuarial...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Humana (Raleigh, NC)
- …factors. This position utilizes financial projection and analytics skills while working in Medicare risk adjustment . Additionally, you will work to build ... + Experience working with Medical Claims or other healthcare data + Medicare Risk Adjustment Experience + Financial or actuarial background + Masters… more
- Humana (Pelham, GA)
- …exceptional follow up skills + Valid Driver's license and reliable transportation + Medicare Risk Adjustment knowledge **Additional Information** Work at ... leadership, webinars public speaking and/or presentation skills with healthcare providers + Risk Adjustment knowledge + Familiar with coding guidelines + Live… more
