- Elevance Health (Mason, OH)
- ** Risk Adjustment Process Expert I** **Location:** Louisville, KY **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering ... an accommodation is granted as required by law. The ** Risk Adjustment Process Expert** is responsible for...adjustment experience strongly preferred. + 3 years of Medicare /Medicaid experience is strongly preferred. + Strong oral, written… more
- Point32Health (Canton, MA)
- …and business division goals. This position will report to the Director of Risk Adjustment Strategy , Operations and Quality Assurance. **Job Description** ... will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Humana (Springfield, IL)
- …of Network Performance, is responsible for the successful execution of Stars and Risk Adjustment strategy and performance within a designated region. ... performance. Provides input into functions strategy . The Director, Quality and Risk Adjustment will be responsible for developing relationships with key… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …trends to support bid development and financial forecasting. * Tracks and evaluates risk adjustment initiatives performance across Medicare , ACA, and ... Cross and Blue Shield of Minnesota Position Title: Director Risk Adjustment and Quality Analytics - Actuarial...risk , care, and health. Your Responsibilities * Performs risk score computation and forecasting for Medicare ,… more
- CareFirst (Baltimore, MD)
- … Manager plays a critical role in the development and execution of the corporate risk adjustment strategy . The role serves as a dedicated resource within ... the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading... strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations… 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...Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA… more
- Molina Healthcare (Ridgeland, MS)
- …ensuring alignment of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert for the health plan. The ... **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading...design, implementation, and monitoring the effectiveness of a comprehensive Risk and Quality intervention strategy , acting as… 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 ... leading the team to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive provider… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …+ Lead Product Strategy : Define and execute the roadmap for the Medicare Advantage Risk Adjustment solution, ensuring alignment with company goals ... a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this critical role, you will… more
- Molina Healthcare (Cleveland, OH)
- …functions. These functions include, but may not be limited to: chart retrieval strategy , risk adjustment retrieval performance, process effectiveness, market ... direction/training/implementation of CMS & State related risk adjustment projects for all lines of business ( Medicare...least 5 years in health plan risk adjustment . * Minimum 4 years Medicaid/ Medicare /Marketplace… more
- Molina Healthcare (San Jose, CA)
- …+ Establishes strategy and operational direction for engaging providers on risk adjustment & quality improvement in collaboration with the Plan President, ... Practice Transformation resources. + Collaborates with Health Plan Network to drive value-based care strategy related to risk adjustment & quality. + Sets… 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 ... to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- ChenMed (Miami, FL)
- …+ Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes and Fee For Service. + Knowledge of applicable federal, ... Revenue Cycle Management (RCM) Optimization manages and organizes revenue strategy activities to maximize cash flow through the creation...incumbent also serves as a subject matter expert on risk - adjustment and medical economics to aid in… more
- Point32Health (NH)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... **Job Summary** The Director of Contracting is responsible for contract strategy , development, negotiation, and implementation for hospitals, physician groups, and… more
- Humana (Baton Rouge, LA)
- …or BSN (unrestricted compact license), or equivalent healthcare experience + Experience with Medicare Risk Adjustment and/or medical coding + Progressive ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor… more
- Humana (Atlanta, GA)
- …assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes ... with relationship owners and HQRI + Monitors and develops strategy with leader and Relationship Owner, tailor's provider group...Coder (CRC) + Experience interacting with healthcare providers + Medicare Risk Adjustment knowledge +… more
- Humana (Denver, CO)
- …leaders and their respective functions with a focus on Provider Engagement, Quality and Medicare Risk Adjustment . The RVP, Network Performance represents the ... is responsible for the overall success of Stars and Risk Adjustment strategy and performance...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Columbia, SC)
- …Finance, Health Care/Administration, RN or a related field + Experience with Medicare Risk Adjustment + Progressive experience with interoperability ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies + Recommends execution strategies and monitor… more
- Humana (Richmond, VA)
- …Finance, Health Care/Administration, RN or a related field + Experience with Medicare Risk Adjustment + Progressive experience with interoperability ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies + Recommends execution strategies and monitor… more
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