- Atrium Health (Charlotte, NC)
- …This leaders will be a key subject matter expert for clinical documentation and risk adjustment coding within the enterprise. This position focuses on priorities ... medical record using a multidisciplinary team process. Exhibits expertise associated with advanced certification in CDI. Partners with Medical and other leaders to… more
- CareOregon (Portland, OR)
- …Responsible for the development, execution, and management of the risk adjustment data analytics programs for the Medicare Advantage and Medicaid programs. ... Medicare Services (CMS) Hierarchical Condition Category (HCC) Risk Adjustment Factor (RAF) models (v24 and...a combination of the following: SQL, SAS, Python + Advanced knowledge of analytics, statistics, and data management Preferred… more
- Tufts Medicine (Burlington, MA)
- …coding meets both established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive knowledge of overall ... to improve overall provider documentation as it pertains to coding and risk adjustment guidelines. Reviews medical records to determine if diagnostic… more
- Corewell Health (Grand Rapids, MI)
- …Three (3) to five (5) years' experience in the healthcare setting, preferably in Risk Adjustment or Medicare /ACA Operations with design and program ... Job Summary As a key leader in the Risk Adjustment team, the successful candidate...of 60,000+ dedicated people-including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing… more
- Henry Ford Health System (Troy, MI)
- The Director of Risk Adjustment & Value Based Payment is an unparalleled opportunity with Henry Ford Health. This pivotal role spearheads strategic endeavors in ... risk adjustment , program management and value-based payment,...successful in its participation in alternative payment models, including risk adjusted contracts, Medicare Shared Savings Program… 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
- CVS Health (Hartford, CT)
- …provider/vendor/network outreach, production management, and reporting for the Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP lines ... required, healthcare finance a plus. Excellent communication skills and negotiations skills Advanced Microsoft Excel, SAS skills desired Advanced skills in… more
- CareOregon (Portland, OR)
- …+ Knowledge of Medicare Advantage bid process + Understanding of various risk adjustment methodologies (eg CDPS+Rx, CMS-HCC, ACG, ERG, MARA) + Strong ... Advantage bid; advise internal leadership on potential bid pricing strategies. + Collaborate with Risk Adjustment team to monitor risk adjustment applied… more
- Nucleusteq (AZ)
- …Tableau, Qlik Sense), and reporting via dashboards and scorecards. * 3 years of experience in Medicare Risk Adjustment and related data sources. * 3 years of ... performance measures and member-level data including Risk Adjustment , and Medicaid Core measures. * Advanced ...dashboards and scorecards. * 5 years of experience in Medicare Risk Adjustment and related… more
- AdventHealth (Shawnee, KS)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders + Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention + Provides… more
- AdventHealth (Hinsdale, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care team). The Social Work Care… more
- St. Luke's University Health Network (Quakertown, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- New York State Civil Service (New York, NY)
- …counseling, etc. Duties Description Associate Psychologist functions as an advanced clinician and provide professional psychological services under the clinical ... substance and/or chemical abuse programs, specialized assessment (functional, personality, risk , competency, vocational, education); design and application of behavioral… more
- Sutter Health (Sacramento, CA)
- …HS Diploma or General Education Diploma (GED) **CERTIFICATION & LICENSURE:** + CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or ... Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid… more
- Intermountain Health (Las Vegas, NV)
- …physicians, advanced practice providers (APP), and other staff about documentation and risk adjustment in order to improve the accuracy of the overall ... mentor to leaders, physicians, APP's, and other staff about documentation and risk adjustment . + Reviews medical records documentation for reimbursement,… more
- UCLA Health (Los Angeles, CA)
- …variety of topics, including pricing, forecasting, reserving, trend analysis, value-based care, and risk adjustment - mainly focusing on MAPD business. This will ... (or actively working to attain) * Four or more years of experience with Medicare Advantage, particularly pricing and bid development, Medicare Part D, or… 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 ... The Senior Healthcare Analyst is responsible for monitoring risk pool performance, communicating financial results and identifying...through encounters prior to their submission to Centers for Medicare & Medicaid Services, and the New York State… more
- Humana (Meridian, ID)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining...use data to drive business outcomes and decisions + Advanced Degree in a quantitative discipline, such as Mathematics,… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... + Contribute towards the maintenance and enhancement of an effective Compliance Risk Assessment Program + Project manage regulator and other external reviews as… more
- ChenMed (Miami, FL)
- …and revenue is attributed to enterprise. + Manage end to end process from Risk Adjustment to claim submission. + Will be accountable stakeholder for the ... management as well as end to end revenue cycle management. As a delegated full- risk company, ensuring we obtain all potential premium dollars from our payor partners… more
