- 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 Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter ... Expert (SME) for risk adjustment with contracted IPAs + Collaborating...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage , STARS/HEDIS program, and NCQA technical… more
- Humana (Sacramento, CA)
- …in-depth evaluation of variable factors **Preferred Qualifications** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in business, ... Quality Reporting and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical...Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… 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
- Amazon (San Francisco, CA)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... TME performance compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data primarily -Medical… 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
- 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
- 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