- Elevance Health (Atlanta, GA)
- ** 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...adjustment experience strongly preferred. + 3 years of Medicare /Medicaid experience is strongly preferred. + Strong oral, written… more
- Baylor Scott & White Health (Atlanta, GA)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... to decision-makers. This role supports program management activities around risk adjustment data management and submissions to...Participates in the workgroup to resolve encounter data and process issues. + Analysis and forecasting of risk… more
- Datavant (Atlanta, GA)
- …and life experiences to realize our bold vision for healthcare. As an Auditor, HCC Risk Adjustment Coder, you will review medical records to identify and code ... using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical… more
- Molina Healthcare (Atlanta, GA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- CVS Health (Atlanta, GA)
- …codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
- Molina Healthcare (Atlanta, GA)
- …functions include, but may not be limited to: chart retrieval strategy, risk adjustment retrieval performance, process effectiveness, market performance, ... 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
- Elevance Health (Atlanta, GA)
- …complex healthcare datasets highly preferred. + Working knowledge of Risk Adjustment methodologies (eg, HCC, CDPS) and applicable Medicare , Medicaid, and ... + Designs and implements automated tools to support ongoing monitoring of compliance and risk adjustment metrics. + Applies machine learning and NLP methods to… more
- Humana (Duluth, GA)
- …exceptional follow up skills + Valid Driver's license and reliable transportation + Medicare Risk Adjustment knowledge **Additional Information** Work at ... public speaking and/or presentation skills with healthcare providers + Risk Adjustment knowledge + Familiar with coding...to surrounding provider offices As part of our hiring process , we will be using an exciting interviewing technology… more
- Molina Healthcare (Atlanta, GA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- Molina Healthcare (Atlanta, GA)
- …with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/ Risk , Director of ... existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting...strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as… more
- Humana (Atlanta, GA)
- …community and help us put health first** The Medical Records Retrieval Specialist/ Risk Adjustment Representative 2 travels to provider offices within the region ... running a Motor Vehicle Report as part of the background check process . **Preferred Qualifications** + Experience in EMR (Electronic Medical Records) system +… more
- CVS Health (Atlanta, GA)
- …consulting, financial strategic analysis. + Understanding of value-based care, including risk adjustment methodologies (eg, HCC coding), quality measurement ... the impact of efforts and adjusting strategies accordingly + Work closely with Medicare Quality team to ensure that reporting highlights areas of improvement at a… more