- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director ... of Medicare Risk Adjustment and Analytics....of Medicare Risk Adjustment and Analytics. This role will...program results, and represent and advocate for the Risk Adjustment Team's business interests in corporate… more
- Elevance Health (Woodbridge, NJ)
- ** Medicare Risk Adjustment Advanced Analytics Analyst** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...Performs data mining and data-driven analyses to evaluate historical program performance and to inform current operating decisions. +… more
- Elevance Health (Louisville, KY)
- ** Medicare Risk Adjustment Advanced...and internal partners to apply the insights to drive risk adjustment program innovation and ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...the right members for the right service, to measure program outcomes, and to support information-based strategic decision making.… 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
- LA Care Health Plan (Los Angeles, CA)
- … and Medicaid Services (CMS) and Department of Health Care Services (DHCS) risk adjustment program changes; incorporate changes and requirements into ... Risk Adjustment Strategies and Initiatives Analytics Program ...to encounters and claims data for risk adjustment for all product lines (Commercial, Medicare ,… more
- Blue KC (Kansas City, MO)
- …and technical teams to develop the tools, processes, and reporting required to ensure a compliant risk adjustment program . + Build and maintain the risk ... **Employee discount program ** **Job Description Summary:** The Director, Government Programs Risk Adjustment & Audit assumes overall leadership of the … more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Risk Adjustment Auditor Educator** -St. Peter's Health Partners - Full-time - Remote ... **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Trinity Health (Syracuse, NY)
- …to conduct Education if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding ... and documentation in alignment with risk adjustment models, conducting audits with analysis...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Highmark Health (Blue Bell, 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
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Director (Remote/Hybrid) **Cost Center:** 682891390 SHP-Strategic ... (United States of America) **Job Description:** **JOB SUMMARY** The Risk Adjustment Revenue Director is a finance...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- Molina Healthcare (Roswell, NM)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Corewell Health (Grand Rapids, MI)
- …achieving related revenue targets.The role is responsible for helping to achieve the risk adjustment program vision, strategies, objectives, and goals. This ... performance indicators (KPIs) measure productivity, quality and overall impact of the company's risk adjustment program , including reporting KPIs on a… more
- CareFirst (Baltimore, MD)
- …and manage tracking tools, dashboards, and metrics for monitoring the progress of the Risk Adjustment Program across all lines of business. Drives member ... oversees the outcomes and operations of risk adjustment across the organization within Medicare Advantage,...coding quality. + Successful completion of a Coding Certificate program from an accredited organization (ie, CPC, CRC, CPMA… more
- Tufts Medicine (Burlington, MA)
- …the greater Boston region. **Job Overview** Under the director of the Director, Risk Adjustment Operations, performs accurate and timely reviews and validations ... of Medicare , Medicaid, Commercial HCCs and DxCG's through medical record...established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive… more
- Centene Corporation (Tallahassee, FL)
- …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare ...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- Centene Corporation (Austin, TX)
- …department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which ... includes implementation of elements of an effective compliance program . Oversee the development of risk assessments...assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to… more
- Humana (Des Moines, IA)
- …a part of our caring community and help us put health first** The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ... Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Representative 2 performs varied activities and moderately complex… 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
- CVS Health (Boston, MA)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- Hartford HealthCare (Hartford, CT)
- … to support documentation practices among contracted providers that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. ... settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds...starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters.… more
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