- Elevance Health (Atlanta, GA)
- …+ Working knowledge of Medicaid is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly ... effectively consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level… more
- Molina Healthcare (Atlanta, GA)
- …modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program ... Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment ...business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. + Analysis and forecasting… more
- Elevance Health (Atlanta, GA)
- …and problem-solving, critical thinking skills strongly preferred. + Healthcare business knowledge related to Risk Adjustment Payment Methodology ... to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions… more
- Datavant (Atlanta, GA)
- … risk adjustment charts + Understanding of Medicare, Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding ... vision for healthcare . We're looking for a Risk Adjustment Trainer to help us uplevel...members of Ciox team + Expertise and understanding of risk adjustment business logic +… more
- Highmark Health (Atlanta, GA)
- …This job provides end-to-end management, delivery and support to new and existing Risk Adjustment Programs. The incumbent will deliver value to the Health ... and deliver large and small scale projects that advance business outcomes and achieve strategic objectives relative to new...and achieve strategic objectives relative to new and existing Risk Adjustment Programs. Supports other key objectives… 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
- Datavant (Atlanta, GA)
- …using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical ... in health data exchange. Our vision is that every healthcare decision is powered by the right data, at...and time management skills. + Working knowledge of the business use of computer hardware and software to ensure… 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...on medical cost, utilization and revenue for multiple Molina Healthcare products. Understands and assess critical UM and CM… 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...related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports to monitor health… more
- Molina Healthcare (Atlanta, GA)
- …regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... **RED ED** **U** **C** **A** **TI** **O** **N** **:** Master's in Business Administration, Public Health, Healthcare Administration, etc. **PR** **E** **FE**… more
- Molina Healthcare (Atlanta, GA)
- …regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare Administration, etc. **PREFERRED… more
- Molina Healthcare (Atlanta, GA)
- …**Preferred License, Certification, Association** Six Sigma Certification PMI Certification Business Analytics/ Risk Management Workforce Certification To all ... deploy workforce management strategies nationwide. Partner with leaders by strategically identifying business needs, and propose solutions in line with the needs of… more
- CenterWell (Atlanta, GA)
- …entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing ... (APD) tool) + Responsible for performance management and strategy development for PCO risk adjustment at the division and market level; Partners with Clinical… more
- RELX INC (Atlanta, GA)
- About the Business : LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Healthcare vertical, our solutions focus on ... the overall development and production of winning sales proposals. Supports primarily the healthcare division of LexisNexis Risk Solutions but will assist other… more
- CenterWell (Atlanta, GA)
- …help us put health first** The Finance Strategy Lead - MRA in the PCO risk adjustment area implements and supports strategy and targeted initiatives aimed at ... processes, education, and compliance as it relates to Medicare Risk Adjustment . Uses data-based insight to direct...trends and develops internal initiatives to meet the ever-evolving business needs. Stays on the cutting age of technology… more
- GE Aerospace (Atlanta, GA)
- …at one of our facilities as the site leader's right hand helping to make business decisions or at headquarters on a larger finance team, we have an opportunity for ... Audit Manager and other team members to execute the audit process, including risk assessment, audit planning, audit execution and reporting results for GE Aerospace.… more
- Humana (Atlanta, GA)
- …factors **Preferred Qualifications** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in business , finance, analytics, or related ... and Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI operations. **Responsibilities**… more
- Datavant (Atlanta, GA)
- …BS degree in business , technology or related field + Knowledge of healthcare industry, payment models, risk adjustment , medical coding, physician ... in health data exchange. Our vision is that every healthcare decision is powered by the right data, at...between internal resources and customers in support of custom risk adjustment projects and reports on project… more
- RELX INC (Alpharetta, GA)
- …to both internal and external clients. Our core expertise lies in mortality risk modeling and analysis, leveraging data from public records, credit history, driving ... machine learning models to produce key attributes that can leverage in risk segmentation models. + Ideating, researching, and designing new and innovative analytics… more
- RELX INC (Atlanta, GA)
- …of our GRC team? About the role: We are seeking an experienced Governance, Risk , and Compliance (GRC) Analyst to lead the development and implementation of our ... successful candidate will have a deep understanding of cybersecurity frameworks, risk management, and compliance standards, and will work collaboratively with… more