- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... Serve as a key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: $76,200 -… more
- BlueCross BlueShield of North Carolina (NC)
- …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll ... Get** + The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous… more
- CenterWell (Des Moines, IA)
- …outcomes + Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- UPMC (Pittsburgh, PA)
- …findings and recommendations to senior management; + Working with and applying knowledge in Medicare Advantage Risk Adjustment Modeling; + Utilizing ... performance measures, associated benchmarks, and other contractual components. Analyze membership, risk score, claim and other available internal and external data,… more
- Highmark Health (Pittsburgh, PA)
- …Develop and oversee programs to ensure comprehensive and accurate diagnosis coding for risk adjusted government programs ( Medicare Advantage , ACA business, ... years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement with complex… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making ... coding policies to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following… more
- Datavant (Lincoln, NE)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and ... execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development...measure product impact, and support value-based client delivery across Medicare Advantage , ACA, and Medicaid programs. The… more
- Centene Corporation (Cheyenne, WY)
- …principles of finance and business to calculate financial outcomes around Medicare risk scores and risk adjustment payments + Support Medicare ... revenue forecasting through analysis of risk adjustment models + Collaborate cross-functionally to plan accruals for risk adjustment payments and… more
- Marshfield Clinic (Marshfield, WI)
- …to both internal and external stakeholders as it relates to Medicare Advantage , ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and ... policies to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of… more
- BrightSpring Health Services (Louisville, KY)
- …(TPA) Regulatory and Compliance Oversight + Ensure compliance with CMS Medicare Advantage regulations, including those related to risk adjustment , STARS ... Officer (COO) is a pivotal member of the Signature Advantage Medicare Advantage (MA) health...+ Deep understanding of CMS regulations, STARS quality measures, risk adjustment methodologies, and value based reimbursement.… more
- Centene Corporation (Providence, RI)
- …and performance of Medicare -focused VBP arrangements across New York, including Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs). This role ... Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with… more
- Hartford HealthCare (Hartford, CT)
- …in a variety of settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds relationships, programs, and processes ... recognition programs and other common practices across the system. *JOB SUMMARY:* The Risk Adjustment Coder Educator develops and implements an enterprise-wide … more
- Sutter Health (Emeryville, CA)
- …population health, or value-based care environments. + Demonstrated success in managing Medicare Advantage or other risk -based contracts. + Proven ... Stars, HEDIS, and regulatory requirements for Medicare Advantage and commercial plans. + Expertise in risk... Advantage and commercial plans. + Expertise in risk - adjustment methodologies and clinical documentation accuracy. +… more
- AdventHealth (Maitland, FL)
- …on all contracts and business lines, including Direct-To-Employer, Commercial, ACA Exchange, Medicare , Medicare Advantage , Bundles, and other Network ... improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o...both for clinical quality and financial performance across the Medicare , Medicare Advantage , and Exchange… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …including, but not limited to, Medicare Product, Medicare Operations, Medicare Compliance, Risk Adjustment , Sales, Marketing, Pharmacy, Health and ... experience demonstrated + Medicare experience a plus + Medicare Advantage and Prescription Drug Plan experience a plus #LI-HYBRID Minimum Education… more
- CenterWell (Phoenix, AZ)
- …**Required Qualifications** + Expertise in value-based care, especially Medicare Advantage , with familiarity of HEDIS/STARS, medical risk adjustment , ... PCO has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality… more
- Sutter Health (Sacramento, CA)
- …International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage , ICD-10-CM, and Centers for Medicare ... procedures. Responsible for pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses… more
- Sutter Health (Sacramento, CA)
- …International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage , ICD-10-CM, and Centers for Medicare ... procedures. Responsible for pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses… more
- Providence (Portland, OR)
- …Direct Commercial pricing, rate setting and rate filing, forecasting, budgeting, and estimating risk adjustment and risk transfer payment amounts. + ... a related field. + 5 years healthcare actuarial experience; Experience working with Medicare Advantage pricing and bid development. + Experience with writing… more