- Elevance Health (Richmond, VA)
- …and guide provider groups on effective use and interpretation of risk adjustment data and KPIs + Advanced skills in Microsoft Office Suite, especially ... to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions… more
- Elevance Health (Richmond, VA)
- …is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly preferred + Advanced skills in Microsoft Office ... consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level consultants on… 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** + ... it's designing innovative insurance products, optimizing pricing strategies, or evaluating advanced care management models. Your work will support key organizational… 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
- 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
- Datavant (Trenton, NJ)
- …+ Knowledge and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... staff/external partners + Oversee the development of complex and advanced ICD-10 and Hierarchical Condition Category (HCC) coding and... Medicare , Commercial and Medicaid risk adjustment business logic and coding +… more
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... also oversee the improvement of clinical documentation accuracy for Medicare and Exchange members. While under the direction of...in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving… more
- Molina Healthcare (Detroit, MI)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures ... the smaller, less advanced Tier 2 and Tier 3 providers have engagement...providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration… more
- AdventHealth (Shawnee, KS)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders + Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention + Provides… more
- AdventHealth (Hinsdale, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care team). The Social Work Care… more
- New York State Civil Service (Monroe, NY)
- …Complete assessments, as needed, including capacity for informed consent, Risk Assessments, MOLST capacity, intelligence testing and measures of adaptive ... committees which include Human Rights Committee, Informed Consent Committee, and Local Risk Management Committee for approval. Participate as a member of the… more
- Healthfirst (NY)
- …+ Transactional healthcare data is the lifeline for our value-based payment model. The Risk Adjustment & Encounters Reporting team is unique, as it relies on ... + Previous work experience within the Healthcare Industry; especially within risk adjustment (Data Analysis, Managing vendor relationships, operational… more
- AmeriHealth Caritas (Newtown Square, PA)
- …quality across Specialty Products. + Analyze Medicare and Medicaid claims, enrollment, risk adjustment , and provider network data using SQL and/or SAS. + ... reimbursement methodologies. + Familiarity with predictive analytics, machine learning, and risk adjustment models. + Understanding of CMS regulations, HIPAA,… more
- Fairview Health Services (St. Paul, MN)
- …Medical Coder (CMC) OR Equivalent certifications, examples include: + Certified Risk Adjustment Coder (CRC), Certified Documentation Expert Outpatient (CDEO), ... Payment Systems (PPS) for inpatient and outpatient hospital services and the Medicare Physician Fee Schedule (MPFS) applicable to professional services. Must be… 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 ... departments and provide leadership of an emerging team in the areas of advanced analytics, sprint planning, platform development, data governance and the delivery of… more
- Sutter Health (Sacramento, CA)
- …HS Diploma or General Education Diploma (GED) **CERTIFICATION & LICENSURE:** + CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or ... Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid… more
- Sutter Health (Sacramento, CA)
- …+ HS Diploma or equivalent education/experience **CERTIFICATION & LICENSURE** + CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA ... Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid… more
- New York State Civil Service (Bedford Hills, NY)
- …Zip Code 10507 Duties Description Associate Psychologist functions as an advanced clinician and provide professional psychological services under the clinical ... substance and/or chemical abuse programs, specialized assessment (functional, personality, risk , competency, vocational, education); design and application of behavioral… more
- Centene Corporation (Cheyenne, WY)
- …shared savings/ risk , capitation, bundled payments), including baseline setting, risk adjustment , performance metrics, and reconciliation logic. + ... and negotiation of Value-Based Care (VBC) arrangements with external vendors across our Medicare , Medicaid, and ACA lines of business. **In this Actuary role, you… more
- Trinity Health (Clive, IA)
- …Demonstrated understanding and experience with Quality Data, Total Cost of Care Data, Risk Adjustment / Risk Score methodologies, financial modeling of APM ... of federal and state legislation regarding accountable care, population health and shared risk design. + Leads analysis and work plans to address organizational gaps… more
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