- 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
- 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
- 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 (West Des Moines, IA)
- …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
- 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 critical ... will drive the strategic planning, development, and optimization of our Medicare Advantage Risk Adjustment solution, ensuring that our deliverables support… more
- Humana (Topeka, KS)
- …ensure compliance with CMS guidelines-all while supporting Humana's Retail bid goals and Medicare Risk Adjustment requirements. This role requires strong ... supporting internal Humana partners. + Ensure compliance with CMS guidelines and Medicare Risk Adjustment standards. + Collaborate with Stars program teams… 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
- Humana (Washington, DC)
- …in a health care and / or Insurance setting + Working knowledge of Medicare Risk Adjustment and/or Stars + Experience utilizing Articulate products ... LMS **Additional Information** This role will be responsible for supporting the Medicare Risk Adjustment Team within the Healthcare Quality Reporting and… more
- Humana (Olympia, WA)
- …nursing (BSN), or a related field, or equivalent work experience. + Experience with Medicare Risk Adjustment and/or medical coding. + Experience with ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor… more
- Humana (Atlanta, GA)
- …+ Certified Risk Coder (CRC) + Experience interacting with healthcare providers + Medicare Risk Adjustment knowledge + Analyzing data to build unique ... provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes data and… more
- Humana (Sacramento, CA)
- …+ Experience working with physician groups, provider contracting, market operations, and Medicare Risk Adjustment and Stars/Quality functions + Knowledge ... and oversight of the annual budget, financial planning and projections, risk management and operational metrics and reporting while working with value-based… 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
- Humana (Cheyenne, WY)
- …internal teams and vendors to resolve issues and maintain compliance with CMS and Medicare Risk Adjustment requirements. + Support auditing processes for ... ownership of critical claims operations that ensure compliance and accuracy for Medicare members. As a Senior Program Delivery Professional, you'll manage vendor… more
- Humana (Denver, CO)
- …operational reporting on progress, challenges, and achievements to management. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Blue KC (Kansas City, MO)
- …analysis and forecasting of that data. **Job Description** + Maintains expert knowledge of Medicare Advantage & ACA Risk Adjustment models + Responsible for ... the functions of the role + Minimum 5 years' experience in Medicare Advantage & ACA Risk Adjustment submission experience **Blue Cross and Blue Shield of… more
- Molina Healthcare (Wisconsin Dells, WI)
- …physical examinations. * Captures and documents annual diagnoses accurately consistent with Medicare risk adjustment . * Conducts comprehensive annual ... Identifies gaps in acute/primary care and chronic disease management. * Identifies medical risk and collaborates with members of the care team to mitigate. *… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …of data. In this role, you'll leverage your knowledge of risk adjustment and healthcare data (primarily Medicare Advantage, Medicaid, and ACA Commercial), ... across the enterprise. The ideal candidate will have experience with risk adjustment , Medicare Advantage, Medicaid, ACA commercial, clinical coding, SQL,… more
- LA Care Health Plan (Los Angeles, CA)
- Risk Adjustment Coding Auditor II Job Category: Accounting/Finance Department: Risk Adjustment Strategies & Initiatives Location: Los Angeles, CA, US, ... to support the safety net required to achieve that purpose. Job Summary The Risk Adjustment Coding Auditor II position is responsible for auditing clinical… more
- Point32Health (Canton, MA)
- …will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product ... Point32Health (https://www.point32health.org/) . **Job Summary** This position will lead the Risk Adjustment Operations & Provider Consulting team responsible… more