- Emanate Health (Covina, CA)
- …MSO personnel on HCC and STAR measures related tasks. Responsible to ensure the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon ... and billers to ensure the appropriate ICD10 and CPT codes submitted for Medicare and Covered CA lines of business. Coding specialist will be responsible to… more
- Elevance Health (Mason, OH)
- ** Risk Adjustment Process Expert I** **Location:** Louisville, KY **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering ... an accommodation is granted as required by law. The ** Risk Adjustment Process Expert** is...adjustment experience strongly preferred. + 3 years of Medicare /Medicaid experience is strongly preferred. + Strong oral, written… more
- 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...process and technical workflow documents. + Understand CMS risk score methodology, including risk score calculation,… more
- 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 decision-makers. This role supports program management activities around risk adjustment data management and submissions to...Participates in the workgroup to resolve encounter data and process issues. + Analysis and forecasting of risk… 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** + ... If you need a reasonable accommodation for any part of the application or hiring process , please notify HR at ###@bcbsnc.com . **For most roles, you can choose where… more
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …Graduate. Certified coder CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment / Medicare Advantage and/or clinical. Plans ... the impact of diagnosis coding on risk adjustment payment models. Understand the audit process ...and supporting clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. Medicare and… 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
- 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
- CareFirst (Baltimore, MD)
- …Abilities (KSAs)** + Knowledge and experience across all regulated markets and mandated risk adjustment submission process & platforms. Expert in regulatory ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical...serves as a dedicated resource within the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading… 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 role ensures… 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) & Medicaid Lines… more
- Datavant (Indianapolis, IN)
- …and life experiences to realize our bold vision for healthcare. As an Auditor, HCC Risk Adjustment Coder, you will review medical records to identify and code ... using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical… more
- CVS Health (Hartford, CT)
- …coding, and/or auditing. Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories CRC ... ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...terminology and anatomy for all body systems.-Understand the audit process for risk adjustment models.… more
- CVS Health (Springfield, IL)
- …codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
- Amazon (CO)
- …our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process , including support for the ... a Program Manager II on the One Medical At - Risk team, you will be the primary builder of...management experience - 3+ years of defining and implementing process improvement initiatives using data and metrics experience -… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …for improvement, and lead efforts to enhance accuracy and efficiency in the risk adjustment process . + Regulatory Compliance: Ensure all products, ... company seeks a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this critical… more
- Molina Healthcare (Cleveland, OH)
- …functions include, but may not be limited to: chart retrieval strategy, risk adjustment retrieval performance, process effectiveness, market performance, ... direction/training/implementation of CMS & State related risk adjustment projects for all lines of business ( Medicare...least 5 years in health plan risk adjustment . * Minimum 4 years Medicaid/ Medicare /Marketplace… more
- Insight Global (Tampa, FL)
- Job Description Insight Global is hiring HCC/ Risk Adjustment Medical coders to support a backlog for inpatient and outpatient Medicare advantage projects . ... or AHIMA, or a CCS. Will be coding more risk adjustment vs profee. Most of the...and non-HCC codes. These markets are still only reviewing Medicare Advantage members. I would say 20-30% of our… 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 Qualified ... programs focused on improving the quality of care for Medicare Advantage & Qualified Health Plan (ACA) Members. +...Health Plans (ACA) including Stars and Risk Adjustment + Experience in consulting to process … 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...have a disability and need a workplace accommodation or adjustment during the application and hiring process ,… more
