- UnitedHealth Group (Columbus, OH)
- …Experience in home-based or community-based care models Familiarity with Medicare Advantage , SNP regulations, and risk adjustment methodologies Excellent ... communication, presentation, and strategic thinking skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive… more
- Pyramid Consulting, Inc. (Tampa, FL)
- Immediate need for a talented Risk Adjustment Coder. This is a 06+months Contract to Permanent opportunity with long-term potential and is located in US(Remote). ... multiple lines of business such as Marketplace (ACA) and Medicare Advantage Follows the Official ICD-10 guidelines...has a complete understanding of these guidelines Follows CMS risk adjustment guidelines and has a complete… more
- Iconma LLC (Lansing, MI)
- … Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage , and their specific compliance ... Business Analyst who can bridge regulatory requirements with operational execution across Medicare Advantage and other risk -bearing programs. The analyst… more
- Navvis (Corvallis, OR)
- …of the latest clinical guidelines, best practices, and healthcare policy changes relevant to Medicare and Medicare Advantage patient populations. As part of ... documentation. Monitor key performance indicators related to HCC coding and risk adjustment . Provider Engagement & Collaboration: Facilitate communication and… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… 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: $76,200 -… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …of strategic considerations and recommendations We're Looking for : + Excellent knowledge of Medicare Advantage risk adjustment programs and industry ... transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program...years of relevant experience, preferably in health insurance + Medicare Advantage and Prescription Drug Plan experience… more
- Elevance Health (Mendota Heights, MN)
- …limited to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data ... for completing diverse and complex projects related to risk adjustment analytics in the Medicare Advantage line of business. **How You Will Make an… more
- Blue KC (Kansas City, MO)
- …knowledge of ACA risk adjustment regulations + Maintain expert knowledge of Medicare Advantage risk adjustment regulations to support runout and ... coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state regulations are maintained. + Own the… more
- CareFirst (Baltimore, MD)
- …the outcomes and operations of risk adjustment across the organization within Medicare Advantage , Medicaid & ACA markets. The Risk Adjustment ... strategic direction, leadership, establishing and maturing key function, overseeing enterprise risk adjustment while identifying areas of improvements and… more
- CenterWell (Baton Rouge, LA)
- …outcomes + Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- Datavant (Providence, RI)
- …an outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and ... up to date with current coding policies for ICD-10, Medicare Advantage , HHS (ACA), and other markets....clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… 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 ... ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment ...+ Prior experience working with EDPS data flows and Medicare Advantage programs is a strong … more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Risk Adjustment Auditor Educator** -St. Peter's Health Partners - Full-time - Remote ... **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for...specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare … more
- Trinity Health (Syracuse, NY)
- …to conduct Education if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding ... and documentation in alignment with risk adjustment models, conducting audits with analysis...specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare … more
- Highmark Health (Blue Bell, PA)
- …Develop and oversee programs to ensure comprehensive and accurate diagnosis coding for risk adjusted government programs ( Medicare Advantage , ACA business, ... years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement with complex… more
- Molina Healthcare (Roswell, NM)
- …in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS ... role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling… more
- Corewell Health (Grand Rapids, MI)
- …+ Physician Practice Management and/or clinical experience. Preferred + Experience implementing risk adjustments programs for Medicare Advantage or ACA ... Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and… more
- Datavant (Lincoln, NE)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and ... execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development...measure product impact, and support value-based client delivery across Medicare Advantage , ACA, and Medicaid programs. The… more
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... in managing end-to-end provider engagement, contract modeling, and performance oversight for Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs).… more
