- Humana (Augusta, ME)
- …to drive efficient, effective, and compliant risk adjustment processes. This Risk Adjustment Risk Management lead position will be responsible ... Management Lead acts as a consultant to the Risk Adjustment team leaders, as programs and...Management and is responsible for oversight of the Risk Adjustment Operations processes. The Risk… more
- Baylor Scott & White Health (Augusta, ME)
- …and external sources to provide insight to decision-makers. This role supports program management activities around risk adjustment data management ... procedure documentation. + Oversee updates to department policies and procedures regarding risk adjustment data management . + Remain current on CMS Risk… more
- Datavant (Augusta, ME)
- …and roadmap for the Data Integration pod within the Retrospective Risk Adjustment Coding Product Suite + **Client Data Management :** Oversee secure and ... to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Coding Data Integration, you will own the data strategy and… more
- Datavant (Augusta, ME)
- …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
- Datavant (Augusta, ME)
- …vision for healthcare. We're looking for experienced and credentialed Auditing Team Lead, HCC Risk Adjustment Coding to become an integral part of our team. The ... for education opportunities in both quality and productivity to management for review and/or action. + Assists in auditing...95% or higher. + Any other tasks required by management . What you will bring to the table: +… more
- Datavant (Augusta, ME)
- …for healthcare. Auditing Supervisor serves as a working supervisor with oversight and management of Risk Adjustment team members. This includes monitoring ... findings on a daily basis, including education on time management and best coding practices. + Provide coaching and...the role. + Report trends for education opportunities to management for review and/or action. + Motivate team members… more
- Datavant (Augusta, ME)
- …using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical ... skills, problem solve, ability to work in a remote environment, and time management skills. + Working knowledge of the business use of computer hardware and… more
- Datavant (Augusta, ME)
- …The individual will provide superior quality by performing audits pertaining to risk adjustment coding efforts. The individual will be responsible for ... role in ensuring coding compliance and accuracy + Monitor the performance of the Risk Adjustment Operations both internally and with coding vendors + Provides… more
- Point32Health (ME)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for… more
- Wolters Kluwer (Augusta, ME)
- …| Wolters Kluwer (https://www.wolterskluwer.com/en/solutions/health-language)** **Coder Workbench Solution:** ** Risk Adjustment Software | Health Language ... or Central time zone, have a solid understanding of risk adjustment in the Healthcare Technology space,...+ Provide comprehensive and insightful sales reports to senior management . + Identify and leverage market opportunities for business… more
- CVS Health (Augusta, ME)
- …the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical ... Coder) or CCS-P (Certified Coding Specialist-Physician) required. + CRC (Certified Risk Adjustment Coder) + Computer proficiency including experience with… more
- L. L. Bean, Inc. (Bangor, ME)
- …and strengths to foster growth and development of the team + Recommends adjustment to staffing levels/schedules to meet work requirements. + Address and respond to ... input, feedback, and coaching. If performance concerns exist, hands off to store management for performance management process + Contributes to Peak planning… more
- RELX INC (Augusta, ME)
- …Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management . You can learn ... be the job for you! About the Business: LexisNexis Risk Solutions is the essential partner in the assessment...MQ, Kafka, and DAPR for secure, reliable messaging, state management , and troubleshoot distributed transactions and event processing. +… more
- Amentum (Augusta, ME)
- …the successful development of correctional intelligence programs to assist in the management of violent extremist and high- risk offenders **REQUIRED SKILLS AND ... designed for the following purpose: Building Responsive and Effective Prison Management Systems to Repatriate, Rehabilitate, Reintegrate, and Prosecute FTFs and may… more
- Point32Health (ME)
- …care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment . In-depth health care reimbursement and managed care business ... analytics required by other departments within Point32Health including Medical Management , Contracting, Payment & Policy, etc. + Utilizing in-depth understanding… more
- Sedgwick (Portland, ME)
- …unassisted up to $10M, including having the ability to address most complex adjustment issues pertaining to damages and coverage; to assist on even larger losses ... + Attention to detail and accuracy + Good time management and organizational skills + Ability to work independently...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive… more
- Sedgwick (Augusta, ME)
- …regardless of size, including having the ability to address any complex adjustment issue and any medium sized and relatively complex National Account. **ESSENTIAL ... + Attention to detail and accuracy + Good time management and organizational skills + Ability to work independently...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive… more
- Martin's Point Health Care (Portland, ME)
- …to their management and strategic deployment. + Provides support to Health Plan risk adjustment activities as needed. + Is conversant with Health Plan key ... (MD) provides clinical leadership and direction to the utilization & care management functions of Martin's Point's Health Plans. The MD works collaboratively with… more
- Humana (Augusta, ME)
- …on progress, challenges, and achievements to management . + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs data ... and flows and uses that knowledge to design and implement master data management solutions. The Lead, Data Quality/Integrity works on problems of diverse scope and… more
- CVS Health (Augusta, ME)
- …metrics** , and **provider performance** + Familiarity with **claims data** , ** risk adjustment ** , or **value-based care models** + **Advanced Analytics:** ... provider efficiency, member outcomes, and the impact of medical management programs. + Collaborate with cross-functional teams, including actuaries, clinicians,… more