- UCLA Health (Los Angeles, CA)
- …direction. You can do all this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of ... Risk Adjustment is instrumental in participating in the planning with...key performance indicators to enable operational excellence within the risk adjustment department. You will be responsible… more
- Somatus (Mclean, VA)
- …Claim processing, customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven ... Overview The Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization's Risk Adjustment … more
- UCLA Health (Los Angeles, CA)
- …internal and external clients. You will also serve as a Subject Matter Expert for Medicare Advantage risk adjustment . Salary offers are determined based ... at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and...offices * Required Certified Professional Coder (CPC-I) certification, Certified Risk Adjustment (CRC) coder AAPC certification, and… more
- The Cigna Group (Mclean, VA)
- …$5,000 in addition to base salary._** This role is responsible for supporting Cigna Medicare Advantage 's Risk Adjustment program for assigned populations ... of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It...risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred. +… more
- CareOregon (Portland, OR)
- …model + Understanding of the CDPS + Rx model + Understanding of Medicare Advantage and OHP risk adjustment regulations and requirements + Knowledge of ... development, execution, and management of the risk adjustment data analytics programs for the Medicare ... adjustment data analytics programs for the Medicare Advantage and Medicaid programs. Assists Director… more
- Providence (NM)
- … Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical background + ... providing critical insights to enhance the performance of our Medicare Advantage plans **We welcome 100% remote...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- Nucleusteq (AZ)
- …data warehouse structures as well as owning data inflows and outflows that support the Medicare Advantage Risk Adjustment teams and efforts. * Design ... consistent with the established specifications and business requirements for the Medicare Advantage Risk Adjustment teams to deliver business… more
- The Cigna Group (Westerville, OH)
- This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational ... between Markets and Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams. The Prospective Program Solutions &… more
- The Cigna Group (Memphis, TN)
- …Chattanooga or Memphis, TN area** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage 's Risk Adjustment & Stars program for ... matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise in ICD-10-CM/outpatient and… more
- CareOregon (Portland, OR)
- …+ Understanding of Medicaid rate setting processes + Knowledge of Medicare Advantage bid process + Understanding of various risk adjustment methodologies ... responsible for managing actuarial analysis related to Medicaid and Medicare Advantage lines of business with a...leadership on potential bid pricing strategies. + Collaborate with Risk Adjustment team to monitor risk… more
- AdventHealth (Maitland, FL)
- …audit concepts + Knowledge of regulations related to data submission for Medicare Advantage , MMP, and Marketplace risk adjustment . + Knowledge of CMS ... programs, and develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Ri Clinical Documentation… more
- Elevance Health (Atlanta, GA)
- …California licensed preferred. + Consulting experience and/or MBA + Experience with Medicare Advantage STARS or Risk Adjustment + Six Sigma or formal ... process improvement experience preferred. + Analytical experience in creating study designs, ROIs and statistical techniques preferred. + Advanced knowledge in health care systems and health policy, quality measures, performance measurement, and quality… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …across medical/pharmacy service categories, benchmarking methodologies, retention/leakage analytics, and Medicare risk adjustment + Solid understanding ... your true colors to blue. What We Need The Medicare Advantage Network Performance Manager, as a...including population health management, quality measurement and performance improvement, risk adjustment and coding, and product management… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …from cross functional business leaders to improve the financial performance of BCBSLA's Medicare Advantage (MA) Line of Business (LOB).This is a collaborative, ... complete understanding and experience with the MA STARs and Risk Adjustment programs, analytical and critical thinking...COO of Government Business, and work closely with the Medicare Advantage Finance, Actuarial - both internal… more
- Point32Health (Canton, MA)
- …this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD) including risk adjustment ... you will be doing** **Data Submission Integrity** + Support Medicare Advantage manager across a range of...timely resolution of production issues pertaining to CMS and risk adjustment data submission, including issue investigation,… more
- Kelsey-Seybold Clinic (Houston, TX)
- …of diagnoses which fall into the HCC model as required by CMS for Medicare Advantage plans. Ensure documentation of diagnoses meets the requirements set forth ... ICD-10-CM Guidelines for Coding and Reporting **Job Title: Supervisor Risk Adjustment & Quality Assurance** **Location: Pearland...HCC coding, ICD coding, and RADV requirements. Knowledge of Medicare Advantage and other HCC entity program… more
- Universal Health Services (Reno, NV)
- …in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial ... accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work will include… more
- Highmark Health (Columbus, OH)
- …using information technology **Preferred** + Understanding of government programs - Medicare Advantage , Medicaid, Affordable Care Act + Demonstrated knowledge ... of risk adjustment principals + Health Insurance and/or managed care industry experience + Provider facing or health system/practice experience + Vendor… more
- Healthfirst (New York, NY)
- …lines of businesses, including finance, clinical, medical economics, risk adjustment , and population health strategy implement Medicare strategy for ... Excel skills + Strong understanding of the healthcare industry marketplace, specific to Medicare Advantage + Self-motivated and driven + Understand and translate… more
- CVS Health (Columbus, OH)
- …Required Qualifications - CPC AAPC or CCA AHIMA certification- 3+ years risk adjustment experience in Medicare advantage or commercial- 3+ years of ... capture. Identifies opportunities to promote quality. Shares best practices in risk adjustment across all sites/regions. Simultaneously manages multiple, complex… more