- Elevance Health (Louisville, KY)
- ** 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
- Molina Healthcare (Louisville, KY)
- …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 (Louisville, KY)
- …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
- Molina Healthcare (Louisville, KY)
- …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 (Louisville, KY)
- …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