- Elevance Health (Atlanta, GA)
- …presentation, and problem-solving, critical thinking skills strongly preferred. + Healthcare business knowledge related to Risk Adjustment Payment ... to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions… more
- Datavant (Atlanta, GA)
- … adjustment charts + Understanding of Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of ... Ciox core values to all members of Ciox team + Expertise and understanding of risk adjustment business logic + Ability to analyze data to determine the root… more
- Molina Healthcare (Atlanta, GA)
- …relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and ... role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling… more
- CVS Health (Atlanta, GA)
- …Health has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will support data analysis, ... business needs. You will be responsible for maintaining risk score model integrity across multiple states and communicate...Knowledge of health insurance concepts - Experience working in risk adjustment - Experience working at a… more
- Humana (Atlanta, GA)
- …**Preferred Qualifications** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in business , finance, analytics, or related field; ... Finance team supports Humana's Healthcare Quality Reporting and Improvement business area, part of the Medicare and...Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… more
- Molina Healthcare (Atlanta, GA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- CenterWell (Atlanta, GA)
- …+ 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
- Humana (Atlanta, GA)
- …+ Demonstrated knowledge of Medicare Advantage program + Demonstrated knowledge of risk adjustment and the Stars quality program + Experience in managed care ... Humana and its management by: + Providing legal advice and support for Humana's Medicare Advantage lines of business ; + Advising on Medicare Advantage… more
- CenterWell (Atlanta, GA)
- …at increasing clinical efficiencies, processes, education, and compliance as it relates to Medicare Risk Adjustment . Uses data-based insight to direct ... The Finance Strategy Lead - MRA in the PCO risk adjustment area implements and supports strategy...trends and develops internal initiatives to meet the ever-evolving business needs. Stays on the cutting age of technology… more
- Molina Healthcare (Atlanta, GA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... without restrictions to practice and free of sanctions from Medicaid or Medicare . **PREFERRED EDUCATION:** Master's in Business Administration, Public Health,… more
- Molina Healthcare (Atlanta, GA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), + Diagnosis Related Groups ... Excellence, Health Plan, and Finance teams through analyzing key business issues related to UM and CM processes and...lead to value + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job… more
- Molina Healthcare (Atlanta, GA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for...achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job… more