- Elevance Health (Richmond, VA)
- …presentation, and problem-solving, critical thinking skills strongly preferred. + Healthcare business knowledge related to Risk Adjustment Payment ... to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions… more
- Datavant (Trenton, NJ)
- … adjustment charts + Understanding of Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of ... Ciox core values to all members of Ciox team + Expertise and understanding of risk adjustment business logic + Ability to analyze data to determine the root… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter Expert ... (SME) for risk adjustment with contracted IPAs + Collaborating...in Health Care Administration, Public Health, Population Health, Finance, Business Analytics or related field and/or equivalent experience *… more
- Elevance Health (Richmond, VA)
- …+ Working knowledge of Medicare is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly ... effectively consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level… 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** + ... You'll lead initiatives that directly impact patient outcomes and business performance-whether it's designing innovative insurance products, optimizing pricing… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent the … more
- CareOregon (Portland, OR)
- …and prepares various production and ad hoc reports aligned with risk adjustment initiatives and strategies for both the Medicare and Medicaid lines of ... risk score related reporting for both the Medicare and Medicaid lines of business by... business by compiling data and executing the risk adjustment models. + Study and analyze… more
- Highmark Health (Pittsburgh, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop...diagnosis coding for risk adjusted government programs ( Medicare Advantage, ACA business , and Medicaid). Also… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …results and learning opportunities to the team. * Serves as a coordinator and key business resource for the Risk Adjustment Coding Coordination Team. * ... and procedures and business rule tools governing the response to Risk Adjustment Data Validation (RADV) Audits, prospective medical record coding, and… more
- Banner Health (AZ)
- **Department Name:** Risk Adjustment **Work Shift:** Day **Job Category:** General Operations **Estimated Pay Range:** $53.63 - $89.38 / hour, based on location, ... (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is...including remote and hybrid opportunities. As the Director of Risk Adjustment , you will lead a dynamic… more
- MVP Health Care (Schenectady, NY)
- Professional, Risk Adjustment Analyst Headquarters Office, 625 State Street, Schenectady, New York, United States of America * Rochester Office, 20 S. Clinton ... improvement. To achieve this, we're looking for a **Professional, Risk Adjustment Analyst** to join #TeamMVP. This...Medicare and commercial exchange populations. + Use Clinical Risk Group (CRG) software to target interventions for improved… more
- Humana (Boise, ID)
- …+ Demonstrating an understanding of departmental and organizational goals and how risk adjustment compliance supports boarder business priorities. Making ... caring community and help us put health first** The Risk Adjustment Compliance Professional 2 supports the...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Salt Lake City, UT)
- …community and help us put health first** The Director, Risk Adjustment Strategy Advancement will provide business intelligence and strategic planning support ... segments and the company at large. The Director, Risk Adjustment Strategy Advancement requires an in-depth...for a seasoned leader to lead strategic planning and business management for the team. The primary objective of… more
- CVS Health (Columbus, OH)
- …Programs experience including Medicare , Commercial ACA, and/or Medicaid. + Risk adjustment working knowledge and understanding. + Process development and ... and target/actual dates of completion. + Support provider performance that improves risk score accuracy through meaningful engagement. + Manage project timelines and… more
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
- Centene Corporation (Providence, RI)
- … Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with ... with Contract management and Service Fund teams to implement monitoring of Medicare -specific VBP contracts, including models with upside/downside risk , shared… more
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... and integrity efforts are in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving system-wide RAF audits ensuring… more
- CVS Health (Cary, NC)
- …Minimum 10+ years of experience in healthcare quality, risk adjustment , revenue integrity, or compliance within a Medicare Advantage setting. ... **Position Summary** Strong understanding of CMS regulations, HEDIS, STAR ratings, risk adjustment , and provider engagement strategies. Demonstrates ability to… more
- Cognizant (Sacramento, CA)
- …and TriZetto implementation methodology around enrollment, reconciliation, encounters and risk adjustment programs in the government sponsored healthcare ... healthcare and government programs particularly within enrollment, reconciliation, encounters and risk adjustment areas. . Strong capabilities and experience in… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …including, but not limited to, Medicare Product, Medicare Operations, Medicare Compliance, Risk Adjustment , Sales, Marketing, Pharmacy, Health and ... and ensure completion of Production Operations projects stemming from mandates or business operational needs + Develop and maintain project documentation to track… more