- Elevance Health (Nashville, TN)
- ** 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 (Nashville, TN)
- + **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 (Nashville, TN)
- …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 (Bowling Green, 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
- Health Care Service Corporation (Nashville, TN)
- …key performance indicators, trends, and financial acumen + Knowledge of Medicare Stars, Medicare Risk Adjustment , and Medicare Finance. + Strong ... the team to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive provider network… more
- Molina Healthcare (Bowling Green, 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 (Bowling Green, 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
- Deloitte (Nashville, TN)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- Molina Healthcare (Bowling Green, KY)
- …provider relations, member services, claims management, payment integrity, pharmacy, quality and risk adjustment . * Acts as a critical segment clinical leader ... level strategy and leadership to a national business segment (ie Medicare , Marketplace, advanced imaging/central utilization management services) in the development… more