- Humana (Frankfort, KY)
- …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 (Frankfort, KY)
- …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 (Frankfort, KY)
- …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 (Frankfort, KY)
- …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 (Frankfort, KY)
- …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 (Frankfort, KY)
- …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 (Frankfort, KY)
- …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
- Molina Healthcare (Lexington, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment , disease ... regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management … more
- Molina Healthcare (Lexington, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment , disease ... regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management … more
- Molina Healthcare (Lexington, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment , disease ... Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and… more
- Molina Healthcare (Lexington, KY)
- …**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ ... years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems * 2+ years of data analysis experience utilizing technical… more
- Molina Healthcare (Lexington, KY)
- **Job Description** **Job Summary** The Director, Clinical Data Acquisition for Risk Adjustment , is responsible for the implementation, monitoring, and oversight ... of all chart collection for Risk Adjustment , RADV, or ...as Electronic Medical Record (EMR) access. This position oversees management of training for all CDA team members as… more
- Molina Healthcare (Lexington, KY)
- …* Minimum 5 years people management experience * Minimum 5 years Risk adjustment audit/RADV experience * Demonstrated knowledge of and experience with chart ... **Job Summary** **Job Summary** The AVP, Clinical Data Acquisition is a key Risk Adjustment (QI) leader within the organization enterprise wide. This position… more
- Molina Healthcare (Lexington, KY)
- …**Job Summary** The In-Home Assessment Program Manager is part of our innovative Risk Adjustment department to assist our diverse team of data leaders, ... risk adjustment experts, and developers in the...healthcare delivery environment, specifically with government sponsored programs, including risk revenue management , strategy and compliancy *… more
- Datavant (Frankfort, KY)
- …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
- CenterWell (Frankfort, KY)
- …GenAI) + Responsible for performance management and strategy development for PCO risk adjustment at the division and market level; Partners with Clinical ... interrelate across the function or segment. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- Wolters Kluwer (Frankfort, KY)
- …| 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 (Frankfort, KY)
- …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
- Molina Healthcare (Lexington, 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 ... revenue management , strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge… more
- Molina Healthcare (Lexington, KY)
- …with proven relationship management responsibilities * Proven experience in risk adjustment , quality, and provider engagement. * Demonstrated ability to ... related field. **PREFERRED EXPERIENCE:** 10+ years managed care experience specifically within Risk Adjustment and/or Quality To all current Molina employees: If… more