- Clever Care Health Plan (Huntington Beach, CA)
- …for assisting with the deployment and implementation of various Stars and Risk adjustment programs tied to medical records retrieval strategies, collecting ... will also be involved with continuous training and education on HEDIS, Stars and Risk Adjustment measures to close gaps in care. Functions & Job Responsibilities… more
- UnitedHealth Group (San Antonio, TX)
- …analytical background within Medicare Advantage or government programs ( Risk Adjustment /STARS Calculation models) Previous experience in provider-facing ... degree Billing and CPT coding experience Clinical data abstraction experience Solid business acumen, especially as it relates to Medicare Medical/clinical… 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 ... others. + Serve as a key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: $78,500… more
- CareFirst (Baltimore, MD)
- …leadership roles. + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial ... organization in making better business decisions. The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience… 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 collaboration ... promoting a dynamic and adaptable workplace. Alternate locations may be considered. The ** Medicare Risk Adjustment Advanced Analyst Senior** is responsible… 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** + ... You'll lead initiatives that directly impact patient outcomes and business performance-whether it's designing innovative insurance products, optimizing pricing… more
- TEKsystems (Sunrise, FL)
- …hedis, admin Additional Skills & Qualifications Associate's degree in Business , Healthcare or equivalent experience. Familiar with Quality Improvement philosophy ... and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business ...of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy,… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… 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)
- …relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and ... 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)
- …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...diagnosis coding for risk adjusted government programs ( Medicare Advantage, ACA business , and Medicaid). Also… more
- CareFirst (Baltimore, MD)
- …budget to control and appropriately allocate resources. + Act as a liaison between the business units and the risk adjustment group by promoting a positive ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical...Adjustment functional areas. **Preferred Qualifications** : Masters in business administration, Masters in Health Administration or Masters in… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …results and learning opportunities to the team. * Serves as a coordinator and key business resource for the Risk Adjustment Coding Coordination Team. * ... and procedures and business rule tools governing the response to Risk Adjustment Data Validation (RADV) Audits, prospective medical record coding, and… 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 role ensures… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota Career Area: Special ... Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is a key leader responsible for shaping risk adjustment strategies,… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and ... role is a key strategic leader who initiates, develops and executes/implements the multi-product risk adjustment strategy set by the executive leaders of Risk… more
- Centene Corporation (Tallahassee, FL)
- … risk adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare experience preferred Pay Range: ... a team responsible for supporting key elements of the Risk Adjustment Compliance program with a focus...focus on the auditing and monitoring functions. Collaborates with business areas to ensure effective prevention, detection, and correction… 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
- Bluestone Physician Services (Stillwater, MN)
- …thorough patient chart reviews to identify opportunities for providers to capture risk adjustment diagnostic codes accurately. The successful candidate will play ... reviews of patient charts to identify gaps in documentation and opportunities for risk adjustment coding improvement. + Collaborate with Bluestone providers and… more
- Providence (Portland, OR)
- …in executing business objectives, developing and implementing strategies for risk adjustment and strategic accounts, and advocating for our organization ... Direct the development and execution of risk adjustment strategies, ensuring alignment with business objectives....+ **Experience:** At least 7 years of experience with Medicare , Medicaid, and Commercial risk adjustment… more
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