- The Cigna Group (Houston, TX)
- …medical claims data (CPT/ICD10) + Experience with HHS ACA (or Medicare ) risk adjustment models; Healthcare Actuarial Modeling or financial modeling ... 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
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment...+ Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. +… more
- Humana (Raleigh, NC)
- …Medical Claims or other healthcare data + Medicare Risk Adjustment Experience + Financial or actuarial background + Masters Degree **Additional ... factors. This position utilizes financial projection and analytics skills while working in Medicare risk adjustment . Additionally, you will work to build… more
- Humana (Louisville, KY)
- …claims or other healthcare data + Medicare risk adjustment experience + Financial or actuarial background **Additional Information** **Interview Format** ... trends and enhances modeling techniques. May possess financial or actuarial background. Understands department, segment, and organizational strategy and operating… more
- BlueCross BlueShield of North Carolina (NC)
- …9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + ... shaping the future of care delivery through data-driven insights and strategic actuarial expertise. You'll lead initiatives that directly impact patient outcomes and… 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 ... Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop...to identify both opportunities and weaknesses in the government's actuarial risk score models to inform better… more
- Molina Healthcare (NY)
- …Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …data validation review. Prepares and submits adjustments to the appropriate processing / adjustment area ( Risk Adjustment / Actuarial Services). * Performs ... right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making… more
- Healthfirst (NY)
- …Product and Actuarial analytical requests. + Experience with CMS/HHS risk adjustment payment methodologies. + Self-motivated, creative problem solver who ... **Duties:** + Develop and maintain risk score forecasting models to assist Actuarial...+ At least 5 years previous work experience within risk adjustment + Credentialed Associate of the… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …vendor performance relative to established contracts. * Collaborate with actuarial , finance, Medicare and risk adjustment to ensure all inputs and ... Medicare Provider Relations team! You will apply broad actuarial principles and modeling technical skills to develop solutions...with actuarial , finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- CareOregon (Portland, OR)
- …forecasting activities, actuarial analyses, accounting operations, financial reporting, risk adjustment and procurement functions. + Supports emerging ... multiple finance functions, including accounting, financial reporting, financial planning, forecasting, actuarial analysis and risk adjustment + Expert… more
- Molina Healthcare (Cincinnati, OH)
- …+ Extensive understanding of Medicare Advantage, ACA and Medicaid risk adjustment processes, including encounter data submission and deletion requirements ... **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 business. This… more
- Point32Health (NH)
- …in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial , and sales. **Job ... and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for… more
- Humana (Jackson, MS)
- …Market Finance Professional works closely with corporate finance, provider engagement, clinical, risk adjustment and quality teams to ensure providers are ... Analyze provider performance under value-based contracts, including cost, utilization, quality, and risk adjustment outcomes. + Develop reports and dashboards to… more
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