- 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
- Elevance Health (Grand Prairie, TX)
- ** Medicare Risk Adjustment Advanced...creating a culture that is designed to advance our strategy but will also lead to personal and professional ... and adaptable workplace. Alternate locations may be considered. The ** Medicare Risk Adjustment Advanced Analyst...of our culture. They are how we achieve our strategy , power our business outcomes and drive our shared… more
- TEKsystems (Sunrise, FL)
- …services. We accelerate business transformation for our customers. Our expertise in strategy , design, execution and operations unlocks business value through a range ... of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on… 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
- Corewell Health (Grand Rapids, MI)
- …role is a key strategic leader who initiates, develops and executes/implements the multi-product risk adjustment strategy set by the executive leaders of ... risk adjustment strategies as applicable. Success will require competence in risk adjustment strategy , an ability to build and scale risk… 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 ... financial returns in a fully compliant manner. Develop a Risk Management governance strategy for the Enterprise...Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop… more
- CareFirst (Baltimore, MD)
- … Manager plays a critical role in the development and execution of the corporate risk adjustment strategy . The role serves as a dedicated resource within ... the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading... strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations… more
- CareFirst (Baltimore, MD)
- …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to blue. Position Summary: This role will provide analytical support to the Risk Adjustment Operations team. We're seeking a detail-oriented, curious, and ... synthesize data; develop analyses and reporting to guide the Medicare strategy . + Assist in creation and...throughout program cycles. + Manage data requirements for different Risk Adjustment activities such as in-home health… more
- MVP Health Care (Schenectady, NY)
- …audits for Medicare and Commercial programs required + Experience in risk adjustment payment models strongly + Intermediate Microsoft Excel skills, including ... To achieve this, we're looking for a **Professional, Sr. Risk Adjustment Analyst** to join #TeamMVP. This...+ Supporting development and execution of a multi-year improvement strategy and annual plan of action to maximize reimbursement.… more
- Ankura (Los Angeles, CA)
- …deliver work and seeks to gain additional opportunities for development in a variety of risk adjustment related areas. Qualifications: + Certified in Risk ... at least five (5) recent years of experience in HCC/ Risk Adjustment and/or RADV Audit Methodology +...at critical inflection points related to conflict, crisis, performance, risk , strategy , and transformation. The Ankura team… more
- Highmark Health (Pittsburgh, PA)
- …to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... accuracy of medical record documentation and coding. Promotes the strategy and capabilities to develop risk management...a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track… 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 ... to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare...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 ... possess financial or actuarial background. Begins to influence department's strategy . Makes decisions on moderately complex to complex issues...working with Medical Claims or other healthcare data + Medicare Risk Adjustment Experience +… more
- Molina Healthcare (Cincinnati, OH)
- …the integrity of enterprise revenue, and enabling the organization's overall risk adjustment strategy . Knowledge/Skills/Abilities + Responsible for ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy , governance, and oversight… more
- Elevance Health (Waukesha, WI)
- …value-based care provider or a healthcare services enablement company-and is well-versed in Medicare and Medicaid risk adjustment policies, RADV auditing, ... This leader brings proven experience in payer and provider risk adjustment initiatives and possesses a deep...Requires experience using RADV protocols and following Center for Medicare and Medicaid Services (CMS) and Affordable Care Act… more
- Point32Health (NH)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... **Job Summary** The Director of Contracting is responsible for contract strategy , development, negotiation, and implementation for hospitals, physician groups, and… more
- Highmark Health (Montpelier, VT)
- …in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS ... central role in the development and execution of the strategy for a given initiative for transformation of workflows...outcomes strategic plan development. + 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value… more
- Humana (Sacramento, CA)
- …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, Health Services requires an in-depth… more
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance + Interview, hire, and supervise… more
