- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … Adjustment Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), ... military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk… more
- Elevance Health (West Des Moines, IA)
- …limited to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data ... performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …company seeks a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this ... you will drive the strategic planning, development, and optimization of our Medicare Advantage Risk Adjustment solution, ensuring that our deliverables… more
- Blue KC (Kansas City, MO)
- …forecasting of that data. **Job Description** + Maintains expert knowledge of Medicare Advantage & ACA Risk Adjustment models + Responsible for all ... of the role + Minimum 5 years' experience in Medicare Advantage & ACA Risk Adjustment submission experience **Blue Cross and Blue Shield of Kansas… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk adjustment ... strategy. The role serves as a dedicated resource within the organization for Medicare Advantage , Medicaid and ACA markets, coordinating and leading the end to… more
- CareFirst (Baltimore, MD)
- …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...supports the execution of the corporate coding strategy across Medicare Advantage , Medicaid, and ACA markets. This… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of...and problem resolution to meet business operational requirements for Medicare Advantage (MA), Affordable Care Act (ACA) &… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Quality & Risk Adjustment Provider Consultant Location: Hybrid | Eagan, Minnesota Career ... * Knowledge of Health Care Quality measures * Certified Risk Adjustment Coder (CRC via AAPC) or...Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …your knowledge of risk adjustment and healthcare data (primarily Medicare Advantage , Medicaid, and ACA Commercial), looking for trends within data and ... stakeholders across the enterprise. The ideal candidate will have experience with risk adjustment , Medicare Advantage , Medicaid, ACA commercial, clinical… more
- Blue KC (Kansas City, MO)
- …groups. + Analyze data and monitor provider metrics to identify risk adjustment , HEDIS or educational opportunities for the Medicare Advantage and ... programs focused on improving the quality of care for Medicare Advantage & Qualified Health Plan (ACA)...business. + Develop educational tools for network providers regarding risk adjustment and HEDIS documentation and coding… more
- Ascension Health (Austin, TX)
- …preferably in outpatient or primary care settings. + Experience with risk adjustment programs ( Medicare Advantage , ACO, ACA HHS, or Medicaid). + ... Strong understanding of HCC models and MEAT documentation requirements. + Proficient in EHR systems (Athena preferred) and coding platforms. + Experience in value-based care or population health environments. + Background working with analytics or data… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …for the execution and day-to-day management of data submissions for ACA Commercial, Medicare , and Medicaid risk adjustment and quality programs. * ... team responsible for maintaining, executing, and evaluating initiative impacts using the risk adjustment and quality analytics models across ACA Commercial, … more
- Intermountain Health (Montpelier, VT)
- **Job Description:** This Position is an entry-level role in Risk Adjustment and will learn to demonstrate general proficiency in the areas of Risk ... Coding for highly regulated government insurance programs such as Medicare Advantage (MA), Medicaid, and the Affordable...to ensure accurate coding practices according to general and risk adjustment coding guidelines as established by… more
- Amazon (Seattle, WA)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... TME performance compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data primarily -Medical… more
- Amazon (IL)
- …current on CPT, ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance. Assign appropriate ICD-10-CM, CPT, and other relevant ... requests in a timely manner. Work collaboratively with the Medicare Risk Operations team to ensure positive...a Profee Coder in an office setting inclusive of risk adjustment coder experience required * 1+… 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 ... **Preferred Job Qualifications:** + Health insurance or healthcare industry experience supporting Medicare Advantage + Knowledge of Medicare Advantage… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …providing needed data and reporting, and partner with actuaries to resolve related risk adjustment issues. The ideal candidate will have experience with ... Encounter Data, Medicare Advantage , Medicaid, ACA commercial, and clinical...BI, and will have experience partnering with actuaries on risk adjustment issues. Your Responsibilities * Performs… more
- Deloitte (Colorado Springs, CO)
- …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider...individual medical and small group markets + Experience with Medicare products, including Medicare Advantage … more
- Humana (Sacramento, CA)
- …+ Experience working with physician groups, provider contracting, market operations, and Medicare Risk Adjustment and Stars/Quality functions + Knowledge ... talent **Use your skills to make an impact** **Required Qualifications** + Knowledge of Medicare , Medicare Advantage and participation in the annual bid… more
- Point32Health (NH)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... and experience working collaboratively with providers. + Preferred: 10-15 years of Medicare Advantage experience. Skill Requirements + Energetic, goal driven… more