- Emanate Health (Covina, CA)
- …MSO personnel on HCC and STAR measures related tasks. Responsible to ensure the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon ... Experience Requirement :** Must have at least one year of experience in Medicare HCC program within IPA, HMO, or clinic setting. Two to five years of coding… more
- Baylor Scott & White Health (Austin, TX)
- …internal and external sources to provide insight to decision-makers. This role supports program management activities around risk adjustment data management ... + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible...such as revenue forecasting and ROI. + Contributes to program improvement by designing and implementing business process and… more
- 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
- Humana (Springfield, IL)
- …our caring community and help us put health first** The Director, Quality and Risk Adjustment has regional oversight of the development and implementation of the ... company Medicare /Medicaid Stars Program . Oversees Stars quality improvement...to increase the plan quality. Has regional oversight of risk adjustment to ensure appropriate implementation of… 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
- Molina Healthcare (Ridgeland, MS)
- **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality ... of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert...MHI RQES and VP Stars in developing the local Medicare Stars work plan and executes on interventions that… more
- Amazon (CO)
- …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
- 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
- Molina Healthcare (San Jose, CA)
- …**Job Duties** + Establishes strategy and operational direction for engaging providers on risk adjustment & quality improvement in collaboration with the Plan ... President, AVP of Quality & Risk Adjustment , and Network team. + Leads...challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health… more
- State of Colorado (Denver, CO)
- …and oversight of the Colorado Youth Detention Continuum; a State-funded, locally administered program that provides services to youth at risk of further ... contacts with parents, families, judges, vendors to affect residential adjustment or community transition of students. Maintains Law Enforcement...2 + years of Direct Experience working with at risk youth in secure/staff secure type program .… 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
- St. Luke's University Health Network (Easton, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- Amazon (San Francisco, CA)
- …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
- 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
- CVS Health (Tallahassee, FL)
- …auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories CRC (HCC)CPMA (Certified ... ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… 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
- 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
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