- CVS Health (Hartford, CT)
- …has an exciting opportunity for a Senior Informatics Manager to join our dynamic Medicaid Risk Adjustment Analytics team! In this role you will provide ... Qualifications + Knowledge of government-regulated healthcare programs such as Medicaid or Medicare + Risk Adjustment...programs such as Medicaid or Medicare + Risk Adjustment experience/knowledge Education + Bachelor's Degree… more
- CVS Health (Tallahassee, FL)
- …in Risk Adjustment payment models for Medicare Advantage, ACA and Medicaid . + Expertise in Risk Adjustment timelines and requirements + Prefer ... redirecting as appropriate. + Confers internally and externally with clients and senior management regarding the organization's goals and objectives. + Coaches the… more
- Humana (Columbus, OH)
- …physician, providers and practice managers. + Supporting HEDIS & Risk Adjustment initiatives and Ohio Department of Medicaid quality initiatives for PRAF, ... Service Experience, Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment . Reporting to the Associate Director and/or… more
- Providence (Portland, OR)
- …budgeting and forecasting techniques. + Demonstrated knowledge in risk adjustment models (commercial, ACA, Medicare, and Medicaid ) + Demonstrated knowledge ... risk sharing and alternative payment amounts, and estimating risk adjustment and risk transfer...key analyses with appropriate level of detail analysis for senior leaders. + Manage vendor and consulting relationships. +… more
- Humana (Pittsburgh, PA)
- …market's performance. **Key Functions** + Maintain collaborative relationships (Provider Engagement, Risk Adjustment , Clinical Teams, etc.) + Instill focus on ... live in PA or MD** + Prior Medicare experience + Provider engagement/education, risk adjustment or related experience + Understanding of CMS Stars, performance… more
- Deloitte (Williamsville, NY)
- …with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with health care reform and working knowledge ... Work you'll do As a Government Health Actuary - Senior Consultant in Deloitte's Human Capital Actuarial and Insurance...health plan/insurance company experience + 1 years' experience with Medicaid managed care rate setting + ASA with progression… more
- Healthfirst (NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), ... located at 100 Church Street, NYC. + As a Senior Healthcare Analyst within Medical Economics, you will manage...achieving desired results. + Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst… more
- CVS Health (Topeka, KS)
- …contracting/network + Knowledge of HEDIS and Pay for Performance metrics, ICD-10 coding, Medicaid risk adjustment methodology, and common billing and common ... Charlottesville, VA + San Antonio, TX + Southern, IL Position Summary This Senior Analyst, Healthcare Quality Management will be a Quality Practice Liaison who… more
- Commonwealth Care Alliance (Boston, MA)
- …**Member Service** Strong knowledge of call center processes and supporting systems. + ** Risk Adjustment ** Experience supporting Medicare risk adjustment ... processes, software systems, and technology platforms that support Medicare and Medicaid Health Plans. **Supervision Exercised:** + No, this position does not… more
- Humana (Columbus, OH)
- …+ Experience working with Medical Claims or other healthcare data + Medicare Risk Adjustment Experience + Masters Degree **Use your skills to make ... Quality Reporting and Improvement (HQRI) is responsible for projecting and tracking risk adjustable revenue. Specifically, this role projects and tracks risk … more
- CVS Health (Columbus, OH)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management.* Actively participate ... in meetings and communication with the State Department of Medicaid in person as needed. * Outward facing position to interact and collaborate with medical /… more
- UNC Health Care (Smithfield, NC)
- …necessary escalate to management patient-level issues stemming from contested charges, Risk Management or Patient Relations. 4. Reviews Cosmetic & Elective account ... to resolve credit balances through refunds or posting adjustments. Compiles Medicare/ Medicaid Cash Reports and quarterly Credit Balance reports. 6. Payor Audits… more
- CVS Health (Atlanta, GA)
- …review, diagnosis coding, and/or auditing.Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition ... Medicaid Services (CMS) for the purpose of risk adjustment processes. Diagnosis codes must be...and decisions using industry standard evidence and tools. Assists senior level staff in providing recommendations for process improvement… more
- Guidehouse (Atlanta, GA)
- …include actuarial modeling tasks such as developing healthcare projections, analyzing risk adjustment impacts, and designing and evaluating value-based contracts ... payments (VBPs), and other pilot program models + Capitation rate development + Risk adjustment calculations of premium + Development of budget projections +… more
- MarketSource (Alpharetta, GA)
- …Summary Responsible for leading a team and driving regulatory compliance and risk mitigation efforts through the organization, by identifying risk areas ... will assist in structuring processes, procedures, and technology to maximize our risk mitigation efforts. Essential Job Functions: * Design, implement, and lead the… more
- Molina Healthcare (Las Vegas, NV)
- **JOB DESCRIPTION** **Job Summary** Responsible for continuous quality improvements and risk adjustment accuracy for all government lines of business. Supports ... updates at the meetings and overall, to health plan Senior Leadership Team meetings. + Leads one or more...**Preferred Education:** Master's Degree **Preferred Experience:** + Experience with risk adjustment and quality metrics with government… more
- Deloitte (Stamford, CT)
- …Medicaid waivers (ie, 1115, 1915 b/c, 1332) + 1+ years experience with risk adjustment mechanisms + 1+ years experience with Provider reimbursement streams ... Capital Actuarial and Insurance Solutions Practice, you will assist Deloitte Senior Managers and Partners in providing strategic and technical consulting services… more
- Commonwealth Care Alliance (Boston, MA)
- …reviews, including claims reviews; call center and digital communications reviews; Medicare Risk Adjustment , HCC, clinical and coding reviews; DRG and medical ... industry standards and best practices. + Conducts regular and ongoing risk -based evaluation of new quality audit/review opportunities, and conducts regular… more
- CenterWell (Las Vegas, NV)
- …with them. **Use your skills to make an impact** **Responsibilities** **_Are you a Risk Adjustment and HCC expert? Do you enjoy educating and leading ... one of the largest and fastest growing value-based care, senior -focused primary care providers in the country, operating over...of HCC codes, improve medication adherence, and identify high risk and emerging risk patients to enhance… more
- Vatica Health (Albany, NY)
- …coding, healthcare billing, quality and Value Based Care measures and metrics. Risk Adjustment knowledge/experience is preferred. + Understanding of Medicare, ... of Clinical Operations collaborates with and reports to the Senior Director of Clinical Operations on clinical and non-clinical...ACD, Medicaid , and health plan benefit structures. + Strong management… more