- Cambia Health Solutions, Inc (Renton, WA)
- …to drive performance improvements in critical objectives such as population health management, Medicare Stars, and Risk Adjustment .Here are some of the ... Provider Performance Director, Medicare Advantage (HEALTHCARE)Telecommute or Tele-Flex Options...Expert on MA programs and objectives such as quality, risk adjustment , and other Medicare … more
- Somatus (Mclean, VA)
- …Claim processing, customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven ... Overview The Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization's Risk Adjustment … more
- UCLA Health (Los Angeles, CA)
- …internal and external clients. You will also serve as a Subject Matter Expert for Medicare Advantage risk adjustment . Salary offers are determined based ... at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and...offices * Required Certified Professional Coder (CPC-I) certification, Certified Risk Adjustment (CRC) coder AAPC certification, and… more
- The Cigna Group (Mclean, VA)
- …$5,000 in addition to base salary._** This role is responsible for supporting Cigna Medicare Advantage 's Risk Adjustment program for assigned populations ... of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It...risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred. +… more
- Providence (NM)
- … Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical background + ... providing critical insights to enhance the performance of our Medicare Advantage plans **We welcome 100% remote...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- Nucleusteq (AZ)
- …data warehouse structures as well as owning data inflows and outflows that support the Medicare Advantage Risk Adjustment teams and efforts. * Design ... consistent with the established specifications and business requirements for the Medicare Advantage Risk Adjustment teams to deliver business… more
- The Cigna Group (Westerville, OH)
- This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational ... between Markets and Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams. The Prospective Program Solutions &… more
- The Cigna Group (Memphis, TN)
- …Chattanooga or Memphis, TN area** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage 's Risk Adjustment & Stars program for ... matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise in ICD-10-CM/outpatient and… more
- AdventHealth (Maitland, FL)
- …audit concepts + Knowledge of regulations related to data submission for Medicare Advantage , MMP, and Marketplace risk adjustment . + Knowledge of CMS ... programs, and develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Ri Clinical Documentation… more
- Elevance Health (Waukesha, WI)
- …California licensed preferred. + Consulting experience and/or MBA + Experience with Medicare Advantage STARS or Risk Adjustment + Six Sigma or formal ... process improvement experience preferred. + Analytical experience in creating study designs, ROIs and statistical techniques preferred. + Advanced knowledge in health care systems and health policy, quality measures, performance measurement, and quality… more
- Martin's Point Health Care (Portland, ME)
- …is responsible the overall development, refinement, maintenance, monitoring and oversight of Medicare Risk Adjustment initiatives and operations. The Senior ... Work" since 2015. Position Summary The Senior Director of Risk Adjustment Operations in our Health Plan...plans. Martin's Point also administers two health plans: Generations Advantage ( Medicare Advantage plans available… more
- Point32Health (Canton, MA)
- …this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD) including risk adjustment ... you will be doing** **Data Submission Integrity** + Support Medicare Advantage manager across a range of...timely resolution of production issues pertaining to CMS and risk adjustment data submission, including issue investigation,… more
- Martin's Point Health Care (Portland, ME)
- …offers a remote work schedule and 2-4 visits to Maine, per year! Join this dynamic Risk Adjustment Team in our Health Plan which is growing and making an impact! ... Apply today for immediate consideration! The Senior Risk Adjustment Analyst in our Health Plan...plans. Martin's Point also administers two health plans: Generations Advantage ( Medicare Advantage plans available… more
- Universal Health Services (Reno, NV)
- …in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial ... accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work will include… more
- Highmark Health (Columbus, OH)
- …using information technology **Preferred** + Understanding of government programs - Medicare Advantage , Medicaid, Affordable Care Act + Demonstrated knowledge ... of risk adjustment principals + Health Insurance and/or managed care industry experience + Provider facing or health system/practice experience + Vendor… more
- Healthfirst (New York, NY)
- …lines of businesses, including finance, clinical, medical economics, risk adjustment , and population health strategy implement Medicare strategy for ... Excel skills + Strong understanding of the healthcare industry marketplace, specific to Medicare Advantage + Self-motivated and driven + Understand and translate… more
- The Cigna Group (Miramar, FL)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage ... Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment , Finance, Marketing, Cross-Segment Contracting, Provider Relations,… more
- The Cigna Group (Houston, TX)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction specific to Medicare Advantage ... but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. +...members contribute to the growth and profitability of the Medicare Advantage business in their market in… more
- CVS Health (Columbus, OH)
- …Required Qualifications - CPC AAPC or CCA AHIMA certification- 3+ years risk adjustment experience in Medicare advantage or commercial- 3+ years of ... capture. Identifies opportunities to promote quality. Shares best practices in risk adjustment across all sites/regions. Simultaneously manages multiple, complex… more
- Universal Health Services (Reno, NV)
- …programs. + At least 3 years of health care experience working with Medicare and/or Commercial risk adjustment programs. Requires working knowledge ... in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial… more
