- UnitedHealth Group (San Antonio, TX)
- …analytical background within Medicare Advantage or government programs ( Risk Adjustment /STARS Calculation models) Previous experience in provider-facing ... WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults.… more
- Elevance Health (Grand Prairie, TX)
- ** Medicare Risk Adjustment Advanced Analyst Senior** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering ... a dynamic and adaptable workplace. Alternate locations may be considered. The ** Medicare Risk Adjustment Advanced Analyst Senior** is responsible for… more
- CareFirst (Baltimore, MD)
- …leadership roles. + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial ... and assist the organization in making better business decisions. The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep… 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** + ... it's designing innovative insurance products, optimizing pricing strategies, or evaluating advanced care management models. Your work will support key organizational… 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 ... adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent the … more
- Molina Healthcare (NY)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... 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
- 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 ... Development and Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs… 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
- University of Utah Health (Murray, UT)
- …responsibility, integrity, quality and trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for our health plan's ... risk adjustment program. + This role is...Excel). + Familiarity with ICD-10-CM coding, HCC mappings, and risk score calculations. **Qualifications (Preferred)** **Preferred** + Medicare… 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 ... Coding (CRC) with at least five (5) recent years of experience in HCC/ Risk Adjustment and/or RADV Audit Methodology + Associate's or Bachelor's degree… more
- Fallon Health (Worcester, MA)
- …or follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Risk Adjustment Analyst (RAA) will be a SME for the MassHealth ... be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for...risk adjustment model(s) and related data submission… more
- Humana (Salt Lake City, UT)
- …**Preferred skills** + FSA or plus relevant advanced degree + Experience with Medicare Part D + Familiarity with Risk Score Data + Python **Additional ... MRA Finance team and plays a critical part in forecasting risk scores and revenue for the Medicare Advantage Part D business. The successful candidate will lead… more
- Hartford HealthCare (Hartford, CT)
- …in a variety of settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds relationships, programs, and processes ... recognition programs and other common practices across the system. *JOB SUMMARY:* The Risk Adjustment Coder Educator develops and implements an enterprise-wide … more
- Healthfirst (NY)
- …from an accredited institution. + At least 5 years previous work experience within risk adjustment + Credentialed Associate of the Society of Actuaries (ASA) + ... supporting Product and Actuarial analytical requests. + Experience with CMS/HHS risk adjustment payment methodologies. + Self-motivated, creative problem solver… more
- Molina Healthcare (Janesville, WI)
- …physical examinations. * Captures and documents annual diagnoses accurately consistent with Medicare risk adjustment . * Conducts comprehensive annual ... **Job Description** **Job Summary** Facilitates advanced practice clinical consultations for enrolled members including...acute/primary care and chronic disease management. * Identifies medical risk and collaborates with members of the care team… 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 ... Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply broad actuarial...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Humana (Raleigh, NC)
- …Advantage beneficiaries. We are seeking a technically skilled engineer to deliver integrated Medicare Advantage risk adjustment solutions that leverage data ... engineers, to build scalable, efficient, and user-friendly solutions in Prospective risk adjustment initiatives related to In-Home Wellness Assessments (IHWA)… more
- AdventHealth (Hinsdale, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders o Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention o Provides… more
- AdventHealth (Bolingbrook, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders o Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention o Provides… more
- Datavant (Indianapolis, IN)
- …outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS ... up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
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