- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director ... of Medicare Risk Adjustment and Analytics....of Medicare Risk Adjustment and Analytics. This role will...program results, and represent and advocate for the Risk Adjustment Team's business interests in corporate… more
- UnitedHealth Group (Eden Prairie, MN)
- …assessment, predictive suspecting, program evaluations, and strategic guidance related to Medicare Advantage Risk Adjustment . The role also requires the ... Caring. Connecting. Growing together. As the Optum Care National Risk Adjustment Healthcare Economics Team, we support...adjustment efforts across our enterprise, primarily focused on Medicare Advantage Risk Modeling. We are internal… more
- Memorial Healthcare System (Hollywood, FL)
- …Professional Coder, HCC - Hierarchical Condition Category Coder, CRC - Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.Additional ... Certified Professional Coder, HCC - Hierarchical Condition Category Coder, CRC Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.… more
- CVS Health (Philadelphia, PA)
- …will provide assessments, advocacy, and comprehensive care coordination services to our highest- risk patients and their caregivers to help them improve their health ... and families surrounding life stage and disease-specific issues, including dementia, adjustment to illness, aging, caregiver support, etc. Meet with care teams… more
- Everlywell (Austin, TX)
- …with a strong understanding of HIPAA, CMS regulations, value-based care models, risk adjustment , and population health management strategies specific to ... as well as future roadmap plans. Monitor and evaluate metrics and program success to measure the efficiency of the business plan. Qualifications: Bachelor's… more
- CVS Health (Indianapolis, IN)
- …will provide assessments, advocacy, and comprehensive care coordination services to our highest- risk patients and their caregivers to help them improve their health ... and families surrounding life stage and disease-specific issues, including dementia, adjustment to illness, aging, caregiver support, etc. Meet with care teams… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director ... of Medicare Risk Adjustment and Analytics....of Medicare Risk Adjustment and Analytics. This role will...program results, and represent and advocate for the Risk Adjustment Team's business interests in corporate… more
- Elevance Health (Woodbridge, NJ)
- ** Medicare Risk Adjustment Advanced Analytics Analyst** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...Performs data mining and data-driven analyses to evaluate historical program performance and to inform current operating decisions. +… more
- Elevance Health (Louisville, KY)
- ** Medicare Risk Adjustment Advanced...and internal partners to apply the insights to drive risk adjustment program innovation and ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...the right members for the right service, to measure program outcomes, and to support information-based strategic decision making.… 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 coding ... 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
- Blue KC (Kansas City, MO)
- …and technical teams to develop the tools, processes, and reporting required to ensure a compliant risk adjustment program . + Build and maintain the risk ... **Employee discount program ** **Job Description Summary:** The Director, Government Programs Risk Adjustment & Audit assumes overall leadership of the … 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...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… 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...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Director (Remote/Hybrid) **Cost Center:** 682891390 SHP-Strategic ... (United States of America) **Job Description:** **JOB SUMMARY** The Risk Adjustment Revenue Director is a finance...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- Molina Healthcare (Roswell, NM)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Corewell Health (Grand Rapids, MI)
- …achieving related revenue targets.The role is responsible for helping to achieve the risk adjustment program vision, strategies, objectives, and goals. This ... performance indicators (KPIs) measure productivity, quality and overall impact of the company's risk adjustment program , including reporting KPIs on a… more
- Centene Corporation (Tallahassee, FL)
- …States.** **Position Purpose:** Manages a team responsible for supporting key elements of the Risk Adjustment Compliance program with a focus on the auditing ... adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare ...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- CareFirst (Baltimore, MD)
- …and manage tracking tools, dashboards, and metrics for monitoring the progress of the Risk Adjustment Program across all lines of business. Drives member ... oversees the outcomes and operations of risk adjustment across the organization within Medicare Advantage,...coding quality. + Successful completion of a Coding Certificate program from an accredited organization (ie, CPC, CRC, CPMA… more
- Tufts Medicine (Burlington, MA)
- …the greater Boston region. **Job Overview** Under the director of the Director, Risk Adjustment Operations, performs accurate and timely reviews and validations ... of Medicare , Medicaid, Commercial HCCs and DxCG's through medical record...established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive… more
- Marshfield Clinic (Marshfield, WI)
- …Risk Adjustment Services is a key leader for commercial and government program actuarial and risk adjustment topics. This role provides financial ... in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP-Actuarial...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
