- Knox Community Hospital (Mount Vernon, OH)
- …preferred 3 years' experience in physician office setting required Experience in Risk Adjustment and quality measures ie (Hedis/Stars, eCQM's, PCMH) Knowledge ... MIPS ) and alternative payment models offered by Centers for Medicare and Medicaid Services (CMS) and patient centered medical home models. Ability to collect,… more
- CVS Health (Workman, MN)
- …a highly motivated and strategic professional to serve as the Medicaid Market Manager for our Risk Adjustment programs. This is a high-visibility role ... level engagement, delivering insights, and demonstrating the value of Medicaid risk adjustment performance to... performance to senior leaders and market partners. The Medicaid Market Manager will serve as the… more
- Marshfield Clinic (Marshfield, WI)
- …and business acumen. **Preferred/Optional:** Working knowledge of CMS and/or Medicaid risk adjustment methodologies. **CERTIFICATIONS/LICENSES** _The ... the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Manager (Remote)...for Security Health Plan's Medicare, Affordable Care Act and Medicaid business. This individual provides development and implementation of… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk ... the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products.… more
- Datavant (Richmond, VA)
- …life experiences to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Coding Data Integration, you will own the ... data strategy and execution for Datavant's Retrospective Risk Adjustment Coding products, driving client data...and management of client data for MA, ACA, and Medicaid plans, ensuring HIPAA and CMS compliance + **Standard… more
- Elevance Health (FL)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CVS Health (FL)
- …the existing program and vendors._ **Required Qualifications:** + _Expertise in Risk Adjustment payment models for MA, ACA and Medicaid ._ + _Expertise in ... with heart, each and every day. **Position Summary** _The Purpose of the Sr. Manager , Business Consultation job is to drive prospective program volume and quality of… more
- Molina Healthcare (Scottsdale, AZ)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... **JOB DESCRIPTION** **Job Summary** The Manager , Medical Economics provides support and consultation to...performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina… more
- CVS Health (OH)
- …role you will serve as a hybrid project manager and subject matter expert in Medicaid Risk Adjustment Medicaid analytics and reporting. You will be ... CVS Health has an exciting opportunity for a Project Manager to join our Risk Adjustment...Knowledge of government-regulated healthcare programs such as Medicare or Medicaid - Knowledge of health insurance concepts - Experience… more
- Healthfirst (NY)
- …from an accredited institution. + At least 5 years previous work experience within risk adjustment + Credentialed Associate of the Society of Actuaries (ASA) + ... our provider community. + Keep abreast of New York Medicaid and Medicare reforms and their impact on the...Product and Actuarial analytical requests. + Experience with CMS/HHS risk adjustment payment methodologies. + Self-motivated, creative… more
- Johns Hopkins University (Baltimore, MD)
- …such as claims processing, premium billing, encounter data, utilization management, risk adjustment , provider contracting, quality metrics, and related ... **General Summary** We are seeking an **_Internal Audit Manager ,_** who demonstrates subject matter expertise in operational internal auditing and the healthcare… more
- Deloitte (Boise, ID)
- …product strategy + Reimbursement models - including value-based care/ACO modeling + Risk adjustment mechanisms + Group insurance products including disability, ... Health Actuary Consulting Manager Human Capital Our Human Capital practice is...including individual medical and small group markets and/or state Medicaid programs The wage range for this role takes… more
- Henry Ford Health System (Troy, MI)
- …value-based reimbursement models and initiatives. Reporting to the Director, Risk Adjustment and Value-Based Payment, the Program Manager is responsible for ... The Program Manager - Population Health & Value-Based Payment has an...departmental staff and multi-disciplinary teams. + Knowledge of Medicare, Medicaid , Blue Cross and other third-party payers billing and… more
- Amazon (Seattle, WA)
- …most customer centric pharmacy option. The Payer Biz Dev team is seeking a Risk Manager I to develop and execute foundational submission, reporting, risk ... involved in cross-functional activity and external PBM & State Medicaid communications. This individual will build and scale operational...management experience - CPCS(R) certification from NAMMS or Certified Risk Manager (CRM) is a plus -… more
- Catholic Health Initiatives (Lufkin, TX)
- …the Market's patient data repository and cost accounting system (McKesson Performance Manager ). Tasks include: * Work with department managers to develop and review ... * Able to perform Payer Contract Compliance Audits to identify payers at risk as needed by Management. + Supports Revenue Cycle functions by maintaining PCON/PEA… more
