- Humana (Louisville, KY)
- …to learn. + Works with other associates in Corporate Finance and Medicare Risk Adjustment + Distills complex financial and non- financial data ... discretion. **Preferred Qualifications** + Financial or actuarial background + Medicare Risk Adjustment Experience + Medicare Advantage or Healthcare… more
- Molina Healthcare (Covington, KY)
- …DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... score models. + Generate and distribute routine reports to support risk adjustment calculations, pricing, and financial reporting. + Extract and compile… more
- Baylor Scott & White Health (Frankfort, KY)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... to provide insight to decision-makers. This role supports program management activities around risk adjustment data management and submissions to CMS. This role… more
- Molina Healthcare (Louisville, KY)
- …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
- Humana (Frankfort, KY)
- …Staff + Works closely with internal stakeholders including Finance, Actuarial, Clinical, Medicare Risk Adjustment , Provider Contracting, and Provider ... analyzes and reports on various market data to connect financial outcomes with operational effectiveness. Humana is seeking to...Regional Vice President of Operations in support of the Medicare Advantage line of business. The Market Finance Lead… more
- Molina Healthcare (KY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to… more
- Molina Healthcare (Covington, KY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to… more
- Humana (Frankfort, KY)
- …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... interrelate across segments and/or enterprise-wide. **Regional VP of Health Services, Humana Medicare Advantage** As the Regional VP of Health Services, you will… more
- Molina Healthcare (Owensboro, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to BH-related RFP sections and review… more
- Humana (Frankfort, KY)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining...flexible packages to give our employees a sense of financial security-both today and in the future, including: +… more
- Deloitte (Louisville, KY)
- …estimates for other Health Plan Actuarial liabilities for Premium Deficiency Reserves, Medicare Risk Adjustment , MLR (Minimum Loss Ratio) Calculations, ... for Incurred But Not Paid (IBNP) claims and Loss Adjustment Expense (LAE) for products covering Medical, Pharmacy, and...Provider Liabilities / Risk -Sharing, and other Contract Reserves / Policy Reserves. +… more
- CVS Health (KY)
- … financial strategic analysis. + Understanding of value-based care, including risk adjustment methodologies (eg, HCC coding), quality measurement frameworks, ... efforts and adjusting strategies accordingly + Work closely with Medicare Quality team to ensure that reporting highlights areas...and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to… more