- Point32Health (Canton, MA)
- … adjustment engagement with senior leaders at contracted provider organizations. + ** Risk Adjustment Program Management and Vendor Evaluation** : The ... provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare ,...Manager will be responsible for risk adjustment program management and… 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 ... to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and… 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...Adjustment . + Successful completion of a Coding Certificate program from an accredited organization (ie, CPC, CRC, CPMA… more
- CareFirst (Baltimore, MD)
- …**Knowledge, Skills and Abilities (KSAs)** + Deep knowledge of regulatory compliance and risk adjustment program integrity. + Experience developing & ... **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes...and problem resolution to meet business operational requirements for Medicare Advantage(MA), Affordable Care Act (ACA) & Medicaid Lines… more
- MVP Health Care (Schenectady, NY)
- …of Hierarchical Condition Categories (HCC)s and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare ... innovative thinking and continuous improvement. To achieve this, we're looking for a ** Risk Adjustment Analyst** to join #TeamMVP. This is the opportunity for… more
- Humana (Topeka, KS)
- …+ Ensure compliance with CMS guidelines and Medicare Risk Adjustment standards. + Collaborate with Stars program teams to manage vendor activities ... relationships that drive in-home health and well-being assessments for Medicare members. As a Program Delivery Lead,...CMS guidelines-all while supporting Humana's Retail bid goals and Medicare Risk Adjustment requirements. This… more
- Amazon (FL)
- …Jan 8, 2026 As a Program Manager II on the One Medical At - Risk team, you will be the primary builder of new and existing capabilities and programs aimed ... at improving health outcomes for our at- risk patient populations. Working within Amazon's mission to be...balancing time, quality, and resources to optimize project and program outcomes * Lead the end-to-end implementation of new… more
- New York State Civil Service (Dix Hills, NY)
- …Master Social Worker, (NY HELPS), Sagamore Children's Psychiatric Center, Risk Management, P27406 Occupational Category Health Care, Human/Social Services Salary ... NY Zip Code 11746 Duties Description The Quality & Risk Management Specialist will play a critical role in...Hiring for Emergency Limited Placement - Statewide (NY HELPS) program if they are licensed and currently registered by… more
- Humana (Salt Lake City, UT)
- …gained from actual experience of chronic condition documentation and coding audits, risk adjustment program implementation and provider education delivery. ... + Assist providers in understanding the CMS - HCC Risk Adjustment program as a...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… 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. +...+ Provide training on Stars measures, risk adjustment coding practices, and Blue KC program … 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)
- …email requests in a timely manner. Work collaboratively with the Medicare Risk Operations team to ensure positive program outcomes. Basic Qualifications * 2+ ... 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… more
- Molina Healthcare (Iowa City, IA)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives ... Practice Transformation plan is in place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** + Ensures assigned Tier 2 &… more
- Centene Corporation (Harrisburg, PA)
- …related experience including quality improvement, HEDIS operations, and Risk Adjustment . Experience with quality rating systems, Medicare products, ... best practices towards achieving market and product quality and risk goals + Serve as subject matter expert in...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- Amazon (Seattle, WA)
- …economics reporting and ad-hoc analysis relating to cost of care management - Medicare Risk score projections and premium estimation -Design and implement ... -Value based care contracting support and ongoing financial and risk analysis. -Support ongoing actuarial support for outside auditor...in value-based care, including CMS initiatives such as the Medicare Shared Savings Program (MSSP) and ACO… 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 ... critical claims operations that ensure compliance and accuracy for Medicare members. As a Senior Program Delivery...accuracy for Medicare members. As a Senior Program Delivery Professional, you'll manage vendor claims processes, monitor… 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 ... required to perform the functions of the role + Minimum 5 years' experience in Medicare Advantage & ACA Risk Adjustment submission experience **Blue Cross… 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
- Hartford HealthCare (Farmington, CT)
- …observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition ... Documentation Integrity (CDI) by providing day-to-day oversight of the program . They also represent and support CDI at the...capture (HCC) codes, risk adjustment , and other high quality documentation outcome measures. .… more
- ChenMed (Miami, FL)
- …and regulations, coding, and reimbursement processes + Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes ... cycle process. The incumbent also serves as a subject matter expert on risk - adjustment and medical economics to aid in the development of revenue related… more