- 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** + ... The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous health and… 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 plan. You will: + Conduct medical record… 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...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage, STARS/HEDIS program, and NCQA technical specifications, a… more
- Elevance Health (Richmond, VA)
- …to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions ... to identify trends, areas for improvement, and opportunities within Medicare markets ad provider networks. + Gather and analyze...stakeholders + Serves as a subject matter expert on Risk Adjustment programs and risk … more
- Elevance Health (Richmond, VA)
- …effectively consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level ... Medicare is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly preferred + Advanced skills in… 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 ... Development and Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs… more
- Datavant (Trenton, NJ)
- …+ Knowledge and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of health insurance plans operations + Deep… more
- Apex Health Solutions (Houston, TX)
- …Current AAPC or AHIMA credential required. Managed Care Experience preferred. Knowledge of Medicare Risk Adjustment required. About Apex Health Solutions ... Specialist Supervisor: Director, VBC Operations Required License(s)/ Certification(s): Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC),… 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
- Hartford HealthCare (Farmington, CT)
- …documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the ... and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. Reporting… more
- CenterWell (Des Moines, IA)
- …+ Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record of ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… 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 ... security audits, and other Production Operations duties + Oversee Medicare Part D Claims audits to ensure that all...of federal legislative, regulatory changes, and industry trends impacting Medicare including Medicare Part D program +… more
- CenterWell (Tallahassee, FL)
- …at increasing clinical efficiencies, processes, education, and compliance as it relates to Medicare Risk Adjustment . Uses data-based insight to direct ... first** The Market Partnership and Finance Strategy Lead - MRA in the PCO risk adjustment area implements and supports strategy and targeted initiatives aimed… more
- Dignity Health (Bakersfield, CA)
- …ad hoc analysis to demonstrate insights and trends related to patient engagement, Medicare risk adjustment , STARS/HEDIS, Medical management, and program ... including payer data sources, including but not limited to; Medicaid, Traditional Medicare , Medicare Advantage, value based programs, among others. 3. Engaging… 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
- UPMC (Pittsburgh, PA)
- …and recommendations to senior management; + Working with and applying knowledge in Medicare Advantage Risk Adjustment Modeling; + Utilizing programming ... performance measures, associated benchmarks, and other contractual components. Analyze membership, risk score, claim and other available internal and external data,… 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 ... Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Risk Adjustment Analyst Department Finance Exemption Status...and reliability. + Calculate risk scores and risk score related reporting for both the Medicare… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making ... coding policies to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following… more
- Trinity Health (Syracuse, NY)
- …Ability to conduct Education if needed. Auditing Experience Posting POSITION PURPOSE: The Risk Adjustment Coding Specialist works in a team environment and is ... adhering to coding guidelines established by the Centers for Medicare and Medicaid Services (CMS). Excellus contract specific RA...education and training will be conducted per Excellus payer risk adjustment coding guidelines and required of… 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
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