• Medicare Risk Adjustment

    CVS Health (Atlanta, GA)
    …to make health care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk ... Adjustment for the Georgia & the Gulf States Medicare Market. This role will have specific responsibility for...have specific responsibility for Georgia in maintaining and improving risk adjustment accuracy by partnering closely with… more
    CVS Health (03/20/24)
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  • Medicare Risk Adjustment

    Elevance Health (Washington, DC)
    …+ GA, ATLANTA + HI, KAPOLEI + IA, W DES MOINES **Description** ** Medicare Risk Adjustment Advanced Analytic Senior ** Location: This position will work a ... PulsePoint locations. **Preferred Location:** Hanover, MD. The ** Medicare Risk Adjustment Advanced Analytic Senior ** Is responsible for creating… more
    Elevance Health (03/05/24)
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  • Assistant Director of Medicare Advantage…

    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...improvement specialists. Additional responsibilities will include: * Collaborate with Senior Data Analyst to identify opportunities for improvement *… more
    UCLA Health (02/03/24)
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  • Risk Adjustment Provider Educator…

    The Cigna Group (UT)
    …$5,000 in addition to base salary._** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in ... 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
    The Cigna Group (03/21/24)
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  • Senior Data Analyst - Risk

    Point32Health (Canton, MA)
    …this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD) including risk adjustment ... and timely resolution of production issues pertaining to CMS and risk adjustment data submission, including issue investigation, business requirements,… more
    Point32Health (03/20/24)
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  • Director Risk Adjustment Encounters…

    Corewell Health (Grand Rapids, MI)
    Adjustment Encounter Reporting & Analytics is a strategic, analytical, critically thinking senior leader in the Risk Adjustment Department, charged with ... overseeing and leading the risk adjustment encounter reporting and analytics functions at Priority Health...Medicare and/or ACA programs including claims, encounters, and risk adjustment methodologies preferred + Strong interpersonal… more
    Corewell Health (03/08/24)
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  • Sr. Coder - Risk Adjustment

    Universal Health Services (Reno, NV)
    …accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work will include ... + 3+ years in CMS coding and documentation guidelines as well as HCC risk adjustment coding practices + CRC Required. + Additional Coding certification preferred… more
    Universal Health Services (03/29/24)
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  • Senior Actuarial Analytics, Medicare

    Providence (OR)
    …for our Medicare Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical ... must empower them._** **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:**...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
    Providence (03/14/24)
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  • Senior Healthcare Data Analyst,…

    Providence (Portland, OR)
    …for this position include:** + Master's Degree + Healthcare organization/health insurer experience + Medicare / ACA / Risk Adjustment / Data Encounter ... the best people, we must empower them._** **Providence Health Plan is calling a Senior Healthcare Data Analyst, Medicare /ACA Data Encounter who will:** + Be… more
    Providence (03/07/24)
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  • Medicare Advantage Network Performance…

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …across medical/pharmacy service categories, benchmarking methodologies, retention/leakage analytics, and Medicare risk adjustment + Solid understanding ... domains, including population health management, quality measurement and performance improvement, risk adjustment and coding, and product management and… more
    Blue Cross Blue Shield of Massachusetts (03/15/24)
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  • Provider Education Data Senior Analyst-…

    The Cigna Group (Memphis, TN)
    …or Memphis, TN area** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned ... 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
    The Cigna Group (03/28/24)
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  • Senior Actuary (Remote)

    Martin's Point Health Care (Portland, ME)
    …on estimates for Risk Revenue. Monitor changes and updates to the risk adjustment approach employed by CMS. + Prepare and analyze monthly estimates ... for Medicare Part D Risk Corridor and Coverage...Quality Management, Program Integrity, Corporate Planning, etc. + Support senior management (Chiefs and VPs) with special projects and… more
    Martin's Point Health Care (01/11/24)
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  • Senior Provider Education Strategy…

    Humana (Washington, DC)
    … Advantage Organization. + Demonstrated ability to deliver on KPIs + Knowledge of Medicare Risk Adjustment and Stars + Exceptional communication and ... caring community and help us put health first** The Senior Provider Education Strategy Advancement Professional will work on...for planning and program ownership of the developing provider risk adjustment (RA) education strategy. If you… more
    Humana (03/27/24)
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  • Senior Medical Director (Tampa, FL)

    VIP Care (Tampa, FL)
    …Electronic Medical Record (EMR) system to review Patient records + Proficiency in Medicare Risk Adjustment + Effective communication and interpersonal skills ... Summary/Objective: The Senior Medical Director is responsible for leading efforts...performance improvement strategies to ensure success in our existing ( Medicare Advantage) as well as net new LOBs. They… more
    VIP Care (01/20/24)
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  • Provider Performance Senior Advisor…

    The Cigna Group (Houston, TX)
    …(which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, Provider Relations, and ... **Role Summary** The Provider Performance Senior Advisor is an integral part of a...and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance… more
    The Cigna Group (03/02/24)
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  • Government Health Actuary Senior Consultant

    Deloitte (Mclean, VA)
    …+ Experience with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with health care reform and working ... Work you'll do As a Government Health Actuary - Senior Consultant in Deloitte's Human Capital Actuarial and Insurance...individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or … more
    Deloitte (01/14/24)
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  • Senior Actuarial Analyst

    UCLA Health (Los Angeles, CA)
    …variety of topics, including pricing, forecasting, reserving, trend analysis, value-based care, and risk adjustment - mainly focusing on MAPD business. This will ... (or actively working to attain) * Four or more years of experience with Medicare Advantage, particularly pricing and bid development, Medicare Part D, or… more
    UCLA Health (01/27/24)
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  • Senior Healthcare Analyst, Medical…

    Healthfirst (New York, NY)
    …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... produce results and deliver impactful business recommendations. As a Senior Medical Economics Analyst, you'll map out and construct...results. + Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their… more
    Healthfirst (03/05/24)
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  • Prospective Program Solutions & Performance…

    The Cigna Group (Bloomfield, CT)
    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 (02/14/24)
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  • Sr. Director, Value Based Care

    Universal Health Services (Reno, NV)
    …programs. + At least 3 years of health care experience working with Medicare and/or Commercial risk adjustment programs. Requires working knowledge ... Responsibilities Job Summary: The Senior Director, Performance Improvement provides strategic leadership in...the Prominence Health umbrella. Emphasis will be centered around risk -based contract performance, risk adjustment ,… more
    Universal Health Services (03/29/24)
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