- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… 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 ... Serve as a key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: $76,200 -… more
- CenterWell (Sacramento, CA)
- …outcomes + Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- Datavant (Sacramento, CA)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and ... execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development...measure product impact, and support value-based client delivery across Medicare Advantage , ACA, and Medicaid programs. The… more
- CenterWell (Sacramento, CA)
- …**Required Qualifications** + Expertise in value-based care, especially Medicare Advantage , with familiarity of HEDIS/STARS, medical risk adjustment , ... PCO has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality… more
- Sutter Health (Sacramento, CA)
- …International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage , ICD-10-CM, and Centers for Medicare ... procedures. Responsible for pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses… more
- WelbeHealth (Los Angeles, CA)
- …Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage /Part D payment models + ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… more
- Providence (CA)
- …Direct Commercial pricing, rate setting and rate filing, forecasting, budgeting, and estimating risk adjustment and risk transfer payment amounts. + ... a related field. + 5 years healthcare actuarial experience; Experience working with Medicare Advantage pricing and bid development. + Experience with writing… more
- Dignity Health (Bakersfield, CA)
- …ad hoc analysis to demonstrate insights and trends related to patient engagement, Medicare risk adjustment , STARS/HEDIS, Medical management, and program ... data, including payer data sources, including but not limited to; Medicaid, Traditional Medicare , Medicare Advantage , value based programs, among others. 3.… more
- Sutter Health (Sacramento, CA)
- …workflows, data management, coding staff specific to clinical documentation improvement and risk adjustment coding initiatives. Manages the day to day operations ... related to Risk Adjustment Coding. Provides oversight to the...requirements, knowledge of Quality Coding requirements such as the Medicare Advantage Coding Program/Hierarchial Condition Category +… more