- 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… 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...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- Highmark Health (Pittsburgh, PA)
- …Develop, oversee and adapt infrastructure (processes, systems, talent) to support an effective risk adjustment program as CMS/HHS/DPW evolves the models and ... for risk revenue management for all government program products (commercial ACA, Medicare , and Medicaid)....direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment … more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …updates, maintaining currency in coding. Evaluates, researches, and recommends enhancements to the risk adjustment program . * Proposes and develops new desk ... right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making… 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 ... Professional, Risk Adjustment Analyst Headquarters Office, 625...will be responsible for performing analytics and reporting on Medicare , Commercial Exchange, and Medicaid/HARP member populations. + Provideanalytical… more
- Marshfield Clinic (Marshfield, WI)
- …Risk Adjustment Services is a key leader for commercial and government program actuarial and risk adjustment topics. This role provides financial ... in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP-Actuarial...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- Humana (Boise, ID)
- …Adjustment Compliance Professional 2 contributes to the execution of the organization's risk adjustment compliance program by supporting and the ... 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
- UPMC (Pittsburgh, PA)
- …team members. Provides audit and coding related support to the internal Risk Adjustment Department. **Responsibilities:** + Utilize standard coding guidelines, ... the specified audit period or review time frame. + Participate in government Risk Adjustment Data Validation audits (RADV) conducting research of internal… more
- CVS Health (Columbus, OH)
- …Programs experience including Medicare , Commercial ACA, and/or Medicaid. + Risk adjustment working knowledge and understanding. + Process development and ... dates of completion. + Support provider performance that improves risk score accuracy through meaningful engagement. + Manage project...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… 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
- Dignity Health (Bakersfield, CA)
- …and trends related to patient engagement, Medicare risk adjustment , STARS/HEDIS, Medical management, and program effectiveness. 8. Ability to communicate ... including payer data sources, including but not limited to; Medicaid, Traditional Medicare , Medicare Advantage, value based programs, among others. 3. Engaging… 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
- 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 ... + Knowledge of federal legislative, regulatory changes, and industry trends impacting Medicare including Medicare Part D program + Knowledge of health plan… more
- AdventHealth (Shawnee, KS)
- **Inpatient Social Worker OR RN-Case Manager Weekend Worker Program Days** **All the benefits and perks you need for you and your family:** + Vision, Medical & ... Dental Benefits from Day One + Student Loan Repayment Program + Received Magnet(R) recognition from the American Nurses...the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for… more
- Molina Healthcare (Detroit, MI)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures ... 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve… more
- Molina Healthcare (Buffalo, NY)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures ... providers in the Health Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve… 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
- Marshfield Clinic (Marshfield, WI)
- …stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy ... and integrity of risk adjustment data submitted to the Centers for ...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- Hartford HealthCare (Farmington, CT)
- …audit and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. ... documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the… more
- Fairview Health Services (St. Paul, MN)
- …documentation for clinical conditions and procedures to reflect severity of illness, risk adjustment , accurate coding, accuracy of patient outcomes, and ... informally, regarding the impact of documentation on patient care, quality metrics, risk adjustment , and correct reimbursement. Adheres to departmental and… more
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