- 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
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Risk Adjustment QA Consultant Location: Hybrid | Eagan, Minnesota Career ... to make a difference, join us. The Impact You Will Have As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, you'll play a critical role in ensuring… 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
- Ankura (New York, NY)
- …investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also support practice ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients. +… more
- Centene Corporation (Tallahassee, FL)
- …States.** **Position Purpose:** Manages a team responsible for supporting key elements of the Risk Adjustment Compliance program with a focus on the auditing and ... of compliance issues. Facilitates and leads external audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit deliverables… more
- Evolent (Helena, MT)
- …You'll Be Doing:** **Manager, Coding Support Specialist** Evolent Care Partners is seeking a Risk Adjustment Coding Support Manager to be a core member of the ... Risk Adjustment Coding Support team. Evolent Care Partners' mission is to partner directly with primary care organizations across the country to improve patient… 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 ... to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following programs,… more
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …professional journey. We invite you to apply today. SUMMARY OF JOB The Certified Risk Adjustment Coding/Audit Reviewer is a physician facing position and must ... - allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models. Understand the audit process for risk adjustment… 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...risk adjustment program. + This role is responsible for analyzing...role is responsible for analyzing medical claims, encounter, and risk adjustment targeting data to identify opportunities… 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
- LA Care Health Plan (Los Angeles, CA)
- Enterprise Risk Adjustment Analyst III Job Category: Accounting/Finance Department: Risk Adjustment Strategies & Initiatives Location: Los Angeles, CA, ... support the safety net required to achieve that purpose. Job Summary The Enterprise Risk Adjustment Analyst III provides a key leadership role in the Risk … 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
- Commonwealth Care Alliance (Boston, MA)
- …the Director of Encounter Data Management within the Revenue Cycle Department, the Risk Adjustment Data Developer is responsible for the design, development, and ... of data systems and tools that support Commonwealth Care Alliance's (CCA) risk adjustment and Hierarchical Condition Category (HCC) revenue programs. This… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Risk Adjustment Analyst provides analytic, technical, and decision support to the ... Risk Adjustment Team utilizing third party software as well as the data warehouse as key sources of data. The Analyst works closely with our internal customers… 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 ... of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports the execution of the corporate coding strategy across Medicare ... risk conditions from the accurate collection, submission, and validation of risk adjustment data. Ensuring compliance with regulatory standards that ensure… more
- Datavant (Augusta, ME)
- …vision for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
- Molina Healthcare (Everett, WA)
- …DESCRIPTION** **Job Summary** Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk ... identify risks. Additional leadership opportunities are available to lead national risk adjustment studies. Prior experience in Medicaid risk adjustment… more
- Providence (Portland, OR)
- …remotely in the states of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you will be the ... cornerstone of our strategic vision. You will oversee risk adjustment programs, spearhead provider education, and enhance engagement to support value-based… more
- Centene Corporation (Tallahassee, FL)
- …from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the ... of compliance issues. Facilitates and leads external audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit deliverables… more
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