- CVS Health (New York, NY)
- …regulatory compliance. Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. Collaborate with internal stakeholders to ... CMS Part C/D operations. 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. 5+ years' experience leading… more
- Selby Jennings (New York, NY)
- …performance Lead the development and filing of premium rates Collaborate with Risk Adjustment and other cross-functional teams to identify opportunities for ... insurers is seeking a Senior Actuary to join its Medicare team. This is a great opportunity for someone...product improvement Provide leadership and mentorship to actuarial staff as needed Qualifications: Bachelor's degree in … more
- Horizon Blue Cross Blue Shield of New Jersey (Newark, NJ)
- …with Enterprise Resource Planning (ERP) systems (Workday). Experience with Billing/Purchasing/Procurement. Medicare , Medicaid, or commercial risk adjustment ... agreements. Assess the quality, timeliness, and completion of incoming data from risk adjustment vendors and calculate financial penalties based on contractual… more
- Elevance Health (New Hyde Park, NY)
- ** Medicare Risk Adjustment Actuarial Analyst III** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... for employment, unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Actuarial Analyst III** is responsible for… more
- Molina Healthcare (Yonkers, NY)
- …Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
