- Humana (Louisville, KY)
- …be considered hybrid based on business discretion. The MRA Finance team supports Humana's Medicare Risk Adjustment business area. The Finance team develops ... eagerness to learn. + Works with other associates in Corporate Finance and Medicare Risk Adjustment + Distills complex financial and non-financial data into… more
- CareFirst (Baltimore, MD)
- …leadership roles. + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial ... the organization in making better business decisions. The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. + Analyze… more
- BlueCross BlueShield of North Carolina (NC)
- …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + ... The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous health and… 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: $78,500 -… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of CMS risk score… more
- Baylor Scott & White Health (Austin, TX)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... to provide insight to decision-makers. This role supports program management activities around risk adjustment data management and submissions to CMS. This role… more
- TEKsystems (Sunrise, FL)
- …Job Description Position Purpose: Schedule appointments gather medical histories and updated member and provider information in support of member outreach and claims ... reimbursement. Education/Experience: High school diploma or equivalent. 0-2 years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Excel skills.… more
- TEKsystems (Sunrise, FL)
- …The Medical Records Coordinator is responsible for scheduling appointments, gathering medical histories, and updating member and provider information to support ... member outreach and claims reimbursement. Responsibilities + Assist members with scheduling office visits with primary care providers. + Retrieve charts from electronic medical record systems and compile medical records for coding purposes. + Make outbound… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …Graduate. Certified coder CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment / Medicare Advantage and/or clinical. Plans ... and supporting clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. Medicare and...Risk Adjustment Data Validation (RADV) Timelines. Medicare and Medicaid regulations and billing guidelines and AMA's… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent the Risk … more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk ... Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance,… 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 initiatives. + Performs data mining and data-driven… more
- Hartford HealthCare (Hartford, CT)
- …in a variety of settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds relationships, programs, and processes ... recognition programs and other common practices across the system. *JOB SUMMARY:* The Risk Adjustment Coder Educator develops and implements an enterprise-wide … more
- Providence (Portland, OR)
- …related field is preferred. + **Experience:** At least 7 years of experience with Medicare , Medicaid, and Commercial risk adjustment processes within a ... in the states of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you will be the cornerstone of… more
- Fallon Health (Worcester, MA)
- …Business, Healthcare, or Information Systems **Experience:** + 7-10+ years' experience in the risk adjustment and Medicare managed care environment + ... on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Senior Director of Risk Adjustment is responsible for the execution and oversight of risk… more
- Apex Health Solutions (Houston, TX)
- …AAPC or AHIMA credential required. * Managed Care Experience preferred. * Knowledge of Medicare Risk Adjustment required. About Apex Health Solutions Apex ... Specialist Supervisor: Director, VBC Operations Required License(s)/ Certification(s): Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC),… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and vendor performance relative to established contracts. * Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply broad actuarial...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Health Care Service Corporation (Chicago, IL)
- …key performance indicators, trends, and financial acumen + Knowledge of Medicare Stars, Medicare Risk Adjustment , and Medicare Finance. + Strong ... the team to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive provider network… more