- Baylor Scott & White Health (Austin, TX)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... to provide insight to decision-makers. This role supports program management activities around risk adjustment data management and submissions to CMS. This role… more
- BlueCross BlueShield of North Carolina (NC)
- …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + ... it's designing innovative insurance products, optimizing pricing strategies, or evaluating advanced care management models. Your work will support key organizational… more
- Humana (Springfield, IL)
- …our caring community and help us put health first** The Director, Quality and Risk Adjustment has regional oversight of the development and implementation of the ... company Medicare /Medicaid Stars Program. Oversees Stars quality improvement programs and...to increase the plan quality. Has regional oversight of risk adjustment to ensure appropriate implementation of… 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 ... role, you will drive the strategic planning, development, and optimization of our Medicare Advantage Risk Adjustment solution, ensuring that our deliverables… 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
- 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
- Amazon (IL)
- …Demonstrates ability to perform accurate and complete chart reviews for Profee and HCC Risk Adjustment * Possesses advanced knowledge and understanding of ... ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance. Assign appropriate ICD-10-CM, CPT,...requests in a timely manner. Work collaboratively with the Medicare Risk Operations team to ensure positive… 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 ... goals. + Provides decision support in the form of advanced statistical analysis/business intelligence (Forecasting, Data Mining, Trending and...of the role + Minimum 5 years' experience in Medicare Advantage & ACA Risk Adjustment… 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 ... to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive...to learn, and are thorough and detail oriented + Advanced degree such as Juris Doctor, post graduate degree;… more
- Humana (Helena, MT)
- …business outcomes. + Lead financial analytics projects, with a focus on outcomes of Medicare risk adjustment operations and initiatives. + Work independently ... actionable insights for non-technical stakeholders. **Preferred Qualifications** + Experience with Medicare Risk Adjustment programs and/or CMS datasets.… more
- Johns Hopkins University (Baltimore, MD)
- …such as claims processing, premium billing, encounter data, utilization management, risk adjustment , provider contracting, quality metrics, and related ... health insurance and managed care programs, including Medicaid and Medicare Advantage. + Deep understanding of the regulatory environment...+ Process Improvement: Advanced + Project Management: Advanced + Risk Analysis: Advanced … more
- AdventHealth (Hinsdale, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders o Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention o Provides… more
- AdventHealth (Shawnee, KS)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders + Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention + Provides… more
- CVS Health (Raleigh, NC)
- …Programs experience including Medicare ,** **Commercial ACA, and/or Medicaid** + ** Risk adjustment working knowledge and understanding** + **Understanding of ... building and maintaining robust data pipelines that power reporting and analytics for risk adjustment and provider performance projects. You'll work closely with… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …internal and external to ensure accuracy. Supervises reporting, valuation, and forecasting of risk adjustment score and revenues to support partners internal and ... adjudication and reporting. + Provides input into product development process. + Projects risk adjustment factors, model impacts of potential payment changes. +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …identify risks and opportunities for improvement. * Collaborate with Pharmacy, Risk Adjustment , Network Management, Care Management, Member Experience, Medical ... leadership for all enterprise quality performance programs across the organization's Medicare , Medicaid, ACA, and Commercial lines of business. This position leads… more
- Molina Healthcare (AZ)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other… more
- St. Luke's University Health Network (Stroudsburg, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. . Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. . Monitors risk assessment using available tools and implements discharge interventions… more
- St. Luke's University Health Network (Quakertown, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- Humana (Gainesville, FL)
- …community and help us put health first** The Medical Record Retrieval Specialist ( Risk Adjustment Representative 3) Travels to provider offices within the region ... The records are reviewed by Humana's Coding staff. The Medical Record Retrieval Representative ( Risk Adjustment Representative 3): + Travel up to 60% of the time… more