- CVS Health (Hartford, CT)
- …solutions to make health care more personal, convenient and affordable. Position Summary The Medicaid Risk Adjustment Sr. Analyst will play a critical role ... economic outcomes, and other business needs. Reporting to the Sr. Manager of Medicaid Risk Adjustment Analytics, the Sr. Analyst will work closely with… more
- Point32Health (Canton, MA)
- …this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD) including risk adjustment ... and timely resolution of production issues pertaining to CMS and risk adjustment data submission, including issue investigation, business requirements,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supports Risk Adjustment & Stars organization to optimize Risk Adjustment revenue and coding accuracy through ... populations. Responsible for developing performance monitoring reports and analytics related to Risk Adjustment & Stars programs and processes. We are looking… more
- AdventHealth (Maitland, FL)
- …to comply with State Medicaid and CMS regulations with respect to Risk Adjustment rules and working with outside vendors to ensure their compliance. ... incentive programs, and develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Ri Clinical… more
- Highmark Health (Columbus, OH)
- …Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits. Works closely with colleagues, ... and compliance), and/or physicians to identify and deliver high quality and accurate risk adjustment coding. Supports all risk adjustment projects to… more
- Providence (Portland, OR)
- …budgeting and forecasting techniques. + Demonstrated knowledge in risk adjustment models (commercial, ACA, Medicare, and Medicaid ) + Demonstrated knowledge ... risk sharing and alternative payment amounts, and estimating risk adjustment and risk transfer...key analyses with appropriate level of detail analysis for senior leaders. + Manage vendor and consulting relationships. +… more
- Healthfirst (New York, NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... needs to produce results and deliver impactful business recommendations. As a Senior Medical Economics Analyst, you'll map out and construct detailed analyses,… more
- Martin's Point Health Care (Portland, ME)
- …on estimates for Risk Revenue. Monitor changes and updates to the risk adjustment approach employed by CMS. + Prepare and analyze monthly estimates ... for Medicare Part D Risk Corridor and Coverage Gap Discounts. Perform annual reconciliation...Quality Management, Program Integrity, Corporate Planning, etc. + Support senior management (Chiefs and VPs) with special projects and… more
- Intermountain Health (Murray, UT)
- …Business Analyst-Technical- Senior is on the Encounter Data team in the Risk Adjustment department. This position will be responsible for understanding and ... A strong candidate will have experience with Encounter Data submissions (EDPS, Medicaid , ACA Edge Server, etc.), experience with the Facets claims adjudication… more
- CVS Health (Columbus, OH)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management* Actively participate in ... meetings and communication with the state Departments of Medicaid in person as needed* Outward facing position to interact and collaborate with medical / physical… more
- Molina Healthcare (Las Vegas, NV)
- **JOB DESCRIPTION** **Job Summary** Responsible for continuous quality improvements and risk adjustment accuracy for all government lines of business. Supports ... updates at the meetings and overall, to health plan Senior Leadership Team meetings. + Leads one or more...key providers. + Participates in state level quality and risk adjustment strategy meetings, develops a quality… more
- CVS Health (Albany, NY)
- …of Disease (ICD) codes required. * Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories ... results to the appropriate departments and management. + Assists senior staff in providing recommendations for process improvements to... Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
- Healthfirst (New York, NY)
- …role: Transactional healthcare data is the lifeline for our value-based payment model. The Risk Adjustment & Encounters Reporting team is unique, as it relies on ... Senior Healthcare Analyst is responsible for monitoring risk pool performance, communicating financial results and identifying areas...prior to their submission to Centers for Medicare & Medicaid Services, and the New York State Department of… more
- WellSense (Boston, MA)
- …teams to capture, value, and scorecard medical cost savings initiatives. + Leads risk adjustment analyses and risk score simulations. + Leads ... across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan,… more
- MarketSource (Alpharetta, GA)
- …Summary Responsible for leading a team and driving regulatory compliance and risk mitigation efforts through the organization, by identifying risk areas ... will assist in structuring processes, procedures, and technology to maximize our risk mitigation efforts. Essential Job Functions: * Design, implement, and lead the… more
- Deloitte (Albany, NY)
- …Medicaid waivers (ie, 1115, 1915 b/c, 1332) + 1+ years experience with risk adjustment mechanisms + 1+ years experience with Provider reimbursement streams ... Capital Actuarial and Insurance Solutions Practice, you will assist Deloitte Senior Managers and Partners in providing strategic and technical consulting services… more
- Molina Healthcare (Albuquerque, NM)
- …Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment , Provider Resolution Team, Provider Appeal and ... This position plans, organizes, staffs, and coordinates the operations of state Medicaid /CHIP, Medicare and Marketplace Health Plan operations. * Works with staff… more
- Deloitte (Colorado Springs, CO)
- …with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + 1 year +experience with risk adjustment mechanisms + 1 year + experience with health care reform and ... and Insurance Solutions Practice, you will assist Deloitte Managers, Senior Managers, and Partners in providing strategic and technical...in the future + 1 year + experience with Medicaid managed care rate setting Preferred: + 1 year… more
- Humana (Columbus, OH)
- …market-based processes that support Provider Engagement, Quality/Stars, Interoperability, and Medicare Risk Adjustment (MRA) business levers. This role calls for ... environment, influencing through communication, and leveraging data to advise senior and executive leaders. This role requires strong leadership, analytical… more
- Molina Healthcare (AZ)
- …Compliance. + History developing Quality Improvement initiatives, population health strategies and risk adjustment programs. + Acts as a lead analyst to ... Arizona are being considered at this time.** **KNOWLEDGE/SKILLS/ABILITIES** The Senior Analyst, Quality Improvement (QI) Interventions/Compliance contributes to either… more