- 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
- Molina Healthcare (Louisville, KY)
- …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
- Molina Healthcare (Louisville, KY)
- …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
- Molina Healthcare (Louisville, KY)
- …activities; and provides direction/training/implementation of CMS & State related risk adjustment projects for all lines of business ( Medicare , Medicaid and ... relevant experience, including at least 5 years in health plan risk adjustment . * Minimum 4 years Medicaid/ Medicare /Marketplace experience. * Minimum 5… more
- Molina Healthcare (Louisville, KY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to… more
- Molina Healthcare (Louisville, KY)
- …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
- Molina Healthcare (Louisville, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to BH-related RFP sections and review… more