- Somatus (Mclean, VA)
- …well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation ... of the organization's Risk Adjustment Programs to optimize the programs'...governing bodies' regulations, including the Center for Medicare and Medicaid Services. This role will partner with leadership to… more
- Banner Health (Phoenix, AZ)
- …leads and develops clinical strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of our MA, MSSP, ... Medicaid , and commercial lines of business. This includes our...as the clinical DYAD to the Executive Director of Risk Adjustment , co-leading a robust team that… more
- Fallon Health (Worcester, MA)
- …and/or work with encounter submissions vendor for resolution + Work with the Senior Risk Adjustment Analyst on monthly operational and performance ... Summary of Purpose** : The primary role of the Risk Adjustment Analyst (RAA) will be to...industry, claims processing, provider billing or Risk Adjustment strongly preferred + * Familiarity with MassHealth/ Medicaid… more
- CenterWell (Carson City, NV)
- …our caring community and help us put health first** The Associate Director, Risk Adjustment oversees quality assurance audits of medical records, ICD-10-CM, CPT, ... that are submitted to the Centers for Medicare and Medicaid Services (CMS), other payers, and over government agencies....and over government agencies. In addition, the Associate Director, Risk Adjustment oversees all medical coding education… more
- Humana (Louisville, KY)
- …position plays a crucial role leading and driving strategic initiatives to optimize risk adjustment operations and solutions that deliver quality outcomes and ... business value. This role impacts our overall Medicare and Medicaid strategy, as it impacts the revenue needed to...will create and own the strategic plan for enterprise risk adjustment operations. This position will report… more
- Geisinger (Danville, PA)
- …Certified Professional Coder - American Academy of Professional Coders (AAPC Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC) ... Minimum of 10 years-Relevant experience* (Required) Certification(s) and License(s) Certified Risk Adjustment Coder - American Academy of Professional Coders… more
- Humana (Columbus, OH)
- …Agile, dedicated Partnership Leaders, and collective Product Ownership to deliver integrated risk adjustment (RA) and quality (Stars) solutions that leverage ... caring community and help us put health first** The Senior Software Engineer solves complex business problems and issues...experience with and knowledge around the CMS Stars and/or Risk Adjustment programs with a focus in… more
- Deloitte (Pittsburgh, PA)
- …with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with health care reform and working knowledge ... organizational performance. Work you'll do As a Government Health Actuary - Senior Consultant in Deloitte's Human Capital Actuarial and Insurance Solutions Practice,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Member Service** Strong knowledge of call center processes and supporting systems. + ** Risk Adjustment ** Experience supporting Medicare risk adjustment ... processes, software systems, and technology platforms that support Medicare and Medicaid Health Plans. **Supervision Exercised:** No, this position does not have… more
- CVS Health (Columbus, OH)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management. * Actively participate ... in meetings and communication with the State Department of Medicaid in person as needed. * Outward facing position to interact and collaborate with medical /… more
- Point32Health (FL)
- …claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment . + Knowledge of Medicare and Medicaid reimbursement is a plus ... members of the Network & Provider Analytics team, the Senior Manager will lead the analytic support of contract...and mentoring to all members of the team. The Senior Manager will directly support complex analysis related to… more
- Humana (Frankfort, KY)
- …a $75B business! In this role, you will support the value story for Humana's risk adjustment and Stars activities overall, as well as end-to-end evaluation and ... and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical members and... regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… more
- Conviva (Tallahassee, FL)
- …entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing ... (APD) tool) + Responsible for performance management and strategy development for PCO risk adjustment at the division and market level; Partners with Clinical… more
- Guidehouse (Atlanta, GA)
- …include actuarial modeling tasks such as developing healthcare projections, analyzing risk adjustment impacts, and designing and evaluating value-based contracts ... payments (VBPs), and other pilot program models + Capitation rate development + Risk adjustment calculations of premium + Development of budget projections +… more
- Hudson Headwaters Health Network (Queensbury, NY)
- …healthcare data (clinical, economic, satisfaction, social determinants) and healthcare analytical methodologies ( risk assessment, risk adjustment , risk ... Patient Centered Medical Home, Pathways, Food as Medicine, NYS Medicaid 1115, , etc.) the VP will collaborate with...etc.) the VP will collaborate with and engage with senior management, medical and Health Center leadership, providers, and… more
- MarketSource (Alpharetta, GA)
- …Summary Responsible for leading a team and driving regulatory compliance and risk mitigation efforts through the organization, by identifying risk areas ... will assist in structuring processes, procedures, and technology to maximize our risk mitigation efforts. Essential Job Functions: * Design, implement, and lead the… more
- Deloitte (Stamford, CT)
- …Medicaid waivers (ie, 1115, 1915 b/c, 1332) + 1+ years experience with risk adjustment mechanisms + 1+ years experience with Provider reimbursement streams ... Capital Actuarial and Insurance Solutions Practice, you will assist Deloitte Senior Managers and Partners in providing strategic and technical consulting services… more
- Molina Healthcare (Albuquerque, NM)
- …Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment , Provider Resolution Team, Provider Appeal and ... This position plans, organizes, staffs, and coordinates the operations of state Medicaid /CHIP, Medicare and Marketplace Health Plan operations. * Works with staff… more
- CareFirst (Baltimore, MD)
- …expertise, drives the company-wide Quality Management program (including CMS Stars and risk adjustment ), and the ongoing development and implementation of health ... programs in a health plan/payor environment, with solid understanding of Stars and risk adjustment . + Prior experience with operations management. + Previous… more
- Humana (Albany, NY)
- …focused in the areas of Provider Contracting, Provider Engagement and Quality, Risk Adjustment , Clinical, and Financial Operations. + Leadership development, ... Market President for the Northeast Region. Reporting to the East Division Senior Vice President, the Regional Market President manages the development, operations,… more