- Humana (Louisville, KY)
- …to learn. + Works with other associates in Corporate Finance and Medicare Risk Adjustment + Distills complex financial and non- financial data ... discretion. **Preferred Qualifications** + Financial or actuarial background + Medicare Risk Adjustment Experience + Medicare Advantage or Healthcare… more
- CareFirst (Baltimore, MD)
- …+ Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial experience). + Strong ... the organization in making better business decisions. The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience… more
- Molina Healthcare (Tampa, FL)
- …DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... score models. + Generate and distribute routine reports to support risk adjustment calculations, pricing, and financial reporting. + Extract and compile… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... trends. Work with team members to understand and monitor the financial impact of risk adjustment programs. Contribute to developing materials and presenting… more
- Baylor Scott & White Health (Austin, TX)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... to provide insight to decision-makers. This role supports program management activities around risk adjustment data management and submissions to CMS. This role… 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** + ... access for Blue Cross NC customers + Achieve segment financial targets and provide concise explanations of results and...of results and variances to expectations; act as a financial steward for the company + Communicate effectively with… more
- Fallon Health (Worcester, MA)
- …for complex analysis, assessment, recommendation and implementation of risk adjustment programs for the following purposes: + Financial Reporting and ... Revenue Strategies + Maximizing Analytics + Reducing Audit and Financial Risk + Closing Data Gaps +...Information Systems **Experience:** + 7-10+ years' experience in the risk adjustment and Medicare managed… 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 ... needs into robust data solutions. + Develop and support risk adjustment financial models that...ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment … more
- Elevance Health (FL)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives....+match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health… 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 ... Lines The Impact You Will Have The Director of Risk Adjustment is a key leader responsible...and driving data integrity, this role enhances care management, risk mitigation, and financial optimization. The ideal… 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 ... the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products.… more
- Highmark Health (Pittsburgh, PA)
- …to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... laws established by the Centers for Medicare and Medicaid Services (CMS), the Department of Health...a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track… more
- Molina Healthcare (WI)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… 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) + ... Manage all analytical audit requests as they relate to Medicare RADV and OIG and prepare financial ...Product and Actuarial analytical requests. + Experience with CMS/HHS risk adjustment payment methodologies. + Self-motivated, creative… more
- Molina Healthcare (AZ)
- …Azure, AWS, or Hadoop + 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment + 3-5 years of experience in working with complex data to ... Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare...include quantifying, measuring, and analyzing financial /performance management and utilization metrics To all current Molina… 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 ... Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to...technically sound as possible. * Lead the modeling of Medicare financial impact and provider financials from… more
- CVS Health (IL)
- …and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. + ... Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories...and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to… more
- CVS Health (OH)
- …Summary** CVS Health has an exciting opportunity for a Project Manager to join our Risk Adjustment Analytics team! In this role you will serve as a hybrid ... project manager and subject matter expert in Medicaid Risk Adjustment Medicaid analytics and reporting. You will be responsible for managing State risk … more
- CVS Health (IN)
- …and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. + ... ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more