- Datavant (Atlanta, GA)
- … adjustment charts + Understanding of Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of ... Ciox core values to all members of Ciox team + Expertise and understanding of risk adjustment business logic + Ability to analyze data to determine the root… more
- Elevance Health (Atlanta, GA)
- …+ Working knowledge of Medicare is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly ... effectively consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level… more
- Humana (Atlanta, GA)
- …+ Demonstrating an understanding of departmental and organizational goals and how risk adjustment compliance supports boarder business priorities. Making ... caring community and help us put health first** The Risk Adjustment Compliance Professional 2 supports the...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Molina Healthcare (Atlanta, GA)
- …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
- Cognizant (Atlanta, GA)
- …and TriZetto implementation methodology around enrollment, reconciliation, encounters and risk adjustment programs in the government sponsored healthcare ... healthcare and government programs particularly within enrollment, reconciliation, encounters and risk adjustment areas. . Strong capabilities and experience in… more
- CenterWell (Atlanta, GA)
- …+ Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record of ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- CenterWell (Atlanta, GA)
- …at increasing clinical efficiencies, processes, education, and compliance as it relates to Medicare Risk Adjustment . Uses data-based insight to direct ... and Finance Strategy Lead - MRA in the PCO risk adjustment area implements and supports strategy...trends and develops internal initiatives to meet the ever-evolving business needs. Stays on the cutting age of technology… more
- Molina Healthcare (Atlanta, GA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... without restrictions to practice and free of sanctions from Medicaid or Medicare . **PREFERRED EDUCATION:** Master's in Business Administration, Public Health,… more
- Evolent (Atlanta, GA)
- …of Medicare claims, episode and condition groupers, case/episode and risk adjustment , patient attribution methodologies, and network analysis and pod ... reason why diversity and inclusion are core to our business . Join Evolent for the mission. Stay for the...Senior Analyst, Performance Analytics to join our Performance Suite business unit. Our mission is to improve and innovate… more