- UnitedHealth Group (San Antonio, TX)
- …network and provider relations Financial analytical background within Medicare Advantage or government programs ( Risk Adjustment /STARS Calculation ... with providers in various care delivery models) Solid knowledge of the Medicare market, products and competitors Knowledge base of clinical standards of care,… more
- Health eCareers (Edinburg, TX)
- …visits, and sponsored health events.Champion a comprehensive, coordinated model of care for Medicare -aged population on a Medicare Advantage Plan and ... Care Resources.Collaborate with our physicians to educate on proper coding, risk adjustment metrics, capture documentation, and follow quality… 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
- 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… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … Adjustment Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), ... military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk… more
- Humana (Cheyenne, WY)
- …beneficiaries. We are seeking a technically skilled Data Engineer 2 to deliver integrated Medicare Advantage risk adjustment solutions that leverage data ... training or meetings may be required. **Preferred Qualifications** + Experience with Medicare Advantage Risk Adjustment programs including IHWA and… more
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment / Medicare Advantage and/or clinical. Plans experience. Familiarity ... 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
- Humana (Raleigh, NC)
- … beneficiaries. We are seeking a technically skilled engineer to deliver integrated Medicare Advantage risk adjustment solutions that leverage ... engineers, to build scalable, efficient, and user-friendly solutions in Prospective risk adjustment initiatives related to In-Home Wellness Assessments (IHWA)… more
- Datavant (Indianapolis, IN)
- …an outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and ... up to date with current coding policies for ICD-10, Medicare Advantage , HHS (ACA), and other markets....clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Robert Half Office Team (Mountlake Terrace, WA)
- …while managing multiple tasks. * Knowledge of healthcare initiatives such as Medicare Advantage and risk adjustment processes. * Attention to detail and ... multiple electronic medical records (EMR) systems. * Collaborate with the Risk Adjustment and Quality Departments to support related initiatives. * Manage strict… more
- Molina Healthcare (Cincinnati, OH)
- …in Director level role or above. + Extensive understanding of Medicare Advantage , ACA and Medicaid risk adjustment processes, including encounter data ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for...processes that track, evaluate, and submit encounter deletions for Medicare Advantage , ACA, and Medicaid lines of… 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 ... ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment ...+ Prior experience working with EDPS data flows and Medicare Advantage programs is a strong … more
- Molina Healthcare (NY)
- …in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS ... role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling… more
- Highmark Health (Blue Bell, PA)
- …Develop and oversee programs to ensure comprehensive and accurate diagnosis coding for risk adjusted government programs ( Medicare Advantage , ACA business, ... years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement with complex… 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...supports the execution of the corporate coding strategy across Medicare Advantage , Medicaid, and ACA markets. This… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment 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 the end to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making ... coding policies to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following… more
- Corewell Health (Grand Rapids, MI)
- …+ Physician Practice Management and/or clinical experience. Preferred + Experience implementing risk adjustments programs for Medicare Advantage or ACA ... Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and… 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 ... throughout program cycles. + Manage data requirements for different Risk Adjustment activities such as in-home health...2-3 years of business experience in health insurance + Medicare Advantage experience a plus + Overall… more
- Humana (Salt Lake City, UT)
- …plays a critical part in forecasting risk scores and revenue for the Medicare Advantage Part D business. The successful candidate will lead efforts to model ... + FSA or plus relevant advanced degree + Experience with Medicare Part D + Familiarity with Risk Score Data + Python **Additional Information** + This role does… more
