- Elevance Health (Tampa, FL)
- …presentation, and problem-solving, critical thinking skills strongly preferred. + Healthcare business knowledge related to Risk Adjustment Payment ... to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions… more
- Datavant (Columbus, OH)
- … adjustment charts + Understanding of Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of ... Ciox core values to all members of Ciox team + Expertise and understanding of risk adjustment business logic + Ability to analyze data to determine the root… more
- CareFirst (Baltimore, MD)
- …**Preferred Qualifications:** + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical, submission cycle, and ... **Resp & Qualifications** **PURPOSE:** The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience in risk … more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter Expert ... (SME) for risk adjustment with contracted IPAs + Collaborating...in Health Care Administration, Public Health, Population Health, Finance, Business Analytics or related field and/or equivalent experience *… more
- Elevance Health (Tampa, FL)
- …Knowledge of SAS and SQL. + Ability to manage multiple projects simultaneously. + Medicare risk adjustment experience highly preferred. Please be advised ... ** Business Change Manager** **Location:** Grand Prairie, TX; Indianapolis,...and resources + Leading various projects that support the Medicare Risk & Recovery Revenue Management -… more
- Robert Half Accountemps (Long Beach, CA)
- …for leading enterprise development of the Medicare Star Ratings and Enterprise Risk Adjustment strategies that ensure our risk adjusted and Star ... quality programs supporting commercial, ACA, and Medicaid lines of business . . Ensure complete, compliant, and accurate risk...military experience will be considered. . Strong knowledge of Medicare Star Ratings and risk adjustment… more
- CareOregon (Portland, OR)
- …and prepares various production and ad hoc reports aligned with risk adjustment initiatives and strategies for both the Medicare and Medicaid lines of ... risk score related reporting for both the Medicare and Medicaid lines of business by... business by compiling data and executing the risk adjustment models. + Study and analyze… more
- Highmark Health (Pittsburgh, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop...diagnosis coding for risk adjusted government programs ( Medicare Advantage, ACA business , and Medicaid). Also… more
- Molina Healthcare (Columbus, OH)
- …relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and ... role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling… more
- Humana (Little Rock, AR)
- …a part of our caring community and help us put health first** The Risk Adjustment Representative 3 conducts quality assurance audits of medical records and ... diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies....and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Representative 3 ensures coding is… more
- CVS Health (Columbus, OH)
- …Health has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will support data analysis, ... business needs. You will be responsible for maintaining risk score model integrity across multiple states and communicate...Knowledge of health insurance concepts - Experience working in risk adjustment - Experience working at a… more
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
- Centene Corporation (Providence, RI)
- … Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with ... with Contract management and Service Fund teams to implement monitoring of Medicare -specific VBP contracts, including models with upside/downside risk , shared… more
- Humana (Columbus, OH)
- …**Preferred Qualifications** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in business , finance, analytics, or related field; ... Finance team supports Humana's Healthcare Quality Reporting and Improvement business area, part of the Medicare and...Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… more
- Molina Healthcare (Columbus, OH)
- …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
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... and integrity efforts are in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving system-wide RAF audits ensuring… more
- System One (Baltimore, MD)
- …in making better business decisions. The individual will interpret and apply Medicare Advantage Risk Adjustment rules, regulations, and processes in ... Partner with cross-functional teams to align data strategies with business needs. + Ensure data accuracy and integrity across...Analyst. + 3-5 years of hands-on experience specifically in Medicare Risk Adjustment . + Strong… more
- Molina Healthcare (Columbus, OH)
- …value-based care, and capitation * Strong working knowledge of Quality metrics and risk adjustment practices across all business lines * Demonstrates ... Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures… more
- Cognizant (Englewood, CO)
- …and TriZetto implementation methodology around enrollment, reconciliation, encounters and risk adjustment programs in the government sponsored healthcare ... healthcare and government programs particularly within enrollment, reconciliation, encounters and risk adjustment areas. . Strong capabilities and experience in… more
- Amazon (New York, NY)
- …economics reporting and ad-hoc analysis relating to cost of care management - Medicare Risk score projections and premium estimation -Design and implement ... (FSA) -Bachelor's degree in Finance, Actuarial Science, Mathematics, Economics, or Business -Experience working with risk -bearing provider groups -Experience in… more