- The Cigna Group (Bloomfield, CT)
- …if do not live near a Cigna Office]** We have an immediate need to strengthen our Risk Adjustment and Stars Enablement team. The Risk Adjustment and ... is responsible for developing solution changes for the ongoing needs of CMS Medicare Risk Adjustment processes and systems. The **Medicare Risk Adjustment… more
- Health First (Rockledge, FL)
- *POSITION SUMMARY* Provide outstanding service by effectively managing and directing the Risk Adjustment team to meet the needs of its internal customers and the ... business objectives, CMS regulations and quality standards for Medicare Advantage and IFP Risk Adjustment . * Develop and manage quality assurance programs for… more
- VNS Health (Manhattan, NY)
- OverviewSupports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk ... industry resources to increase knowledge and improve return on investment (ROI) of risk adjustment activities. Understands risk adjustment models… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Specialist supports prospective risk adjustment via concurrent review and supplemental ... data CMS filing, HHS- Risk Adjustment Data Validation (RADV) audit and...by the federal government. Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions.… more
- UCLA Health (Los Angeles, CA)
- …+ A Certified Professional Coder (CPC) certification and a Certified Risk Adjustment Coder (CRC), required + Bachelor's degree ( healthcare or relevant field) ... Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and...NCQA technical specifications, required + Knowledge of Medicare Advantage billing/ claims submission and other related actions, preferred + Knowledge… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** **Description:** **CERTIFIED RISK ADJUSTMENT CODING SPECIALIST** **Location:** Trinity Health PACE Corp Michigan ... to participant health information for data retrieval, analysis, and claims processing. Duties also include abstracting and validating data...+ Must be certified or obtaining certification for Certified Risk Adjustment Coder thru AAPC. If not… more
- Elevance Health (Atlanta, GA)
- …areas including but not limited to: claims , grievances and appeals, Part D and risk adjustment . + Knowledge of Risk Adjustment Payment methodologies ... a BA/BS and a minimum of 10 years of healthcare , regulatory, ethics, compliance, or privacy experience, including a...and the CMS HCC Model. + Healthcare operations and/or compliance experience within a large payor… more
- Elevance Health (Denver, CO)
- …would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:** Risk Adjustment Data experience is strongly preferred. * Knowledge ... **Business Change Director- Claims /Payment Integrity Use-Case Lead** **Location:** This position will...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Commonwealth Care Alliance (Boston, MA)
- …including the MHK Market Prominence platform. **Knowledge, Skills & Abilities Required:** ** Healthcare Claims ** Strong knowledge of healthcare claims ... and data, including payment integrity, pricing, editing, encounter submission, and risk adjustment **Cloud Computing Technologies** Knowledge of cloud computing… more
- Molina Healthcare (AZ)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms… more
- LA Care Health Plan (Los Angeles, CA)
- …analysis on healthcare data (especially encounters). Preferred: Experience with Risk Adjustment methodologies. Experience with claims , clinical, and/or ... and electronic medical record systems. Analytics experience in management, actuarial/ healthcare economics, risk adjustment and...skills Preferred: Knowledge of managed care and health care claims Knowledge of Risk Adjustment … more
- Healthfirst (NY)
- …sum product, array formulas). + Knowledge of SQL, Medicaid/Medicare programs, Healthcare Claims and/or reimbursement preferred. Minimum Qualifications: + ... sum product, array formulas). + Knowledge of SQL, Medicaid/Medicare programs, Healthcare Claims and/or reimbursement preferred. Preferred Qualifications: +… more
- Molina Healthcare (Phoenix, AZ)
- …Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment , Provider Resolution Team, Provider Appeal and ... Plan's operational departments, programs and services, in alignment with Molina Healthcare 's overall mission, core values, and strategic plan and in compliance… more
- Molina Healthcare (Phoenix, AZ)
- …regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and… more
- Molina Healthcare (NY)
- …-Self-starter and comfortable working in a fast-paced environment + -Knowledge of Risk Adjustment , Quality, and Provider Engagement Strategies + -Experience with ... Healthcare data (Member, Provider, Claims , etc.) + -Vendor Management + -Experience with IT projects (onboarding vendors, file layouts, translating data… more
- Genesis Healthcare (Kennett Square, PA)
- …topics driving outcomes including, but not limited to: financial performance, risk adjustment , utilization management, quality performance, clinical performance, ... those within the Compliance and Ethics Program, Standard/Code of Conduct, Federal False Claims Act and HIPAA. + Provides leadership and support for the Compliance… more
- CVS Health (Overland Park, KS)
- …with large Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis -Excellent oral & written communication skills; ... do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA...actionable insights for our partners and our ACOs using claims and real-time data. + Build models to help… more
- AdventHealth (Maitland, FL)
- …professional and facility claims and managed care concepts such as risk adjustment , capitation, FFS, DRG, APG, APCs and other payment mechanisms ... interface tools + Performs analysis of complex and varied healthcare data including financial modeling and risk ...knowledge of healthcare managed care contracts and healthcare administrative claims data + Employs existing… more
- Centene Corporation (Jefferson City, MO)
- …and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Identifies ... regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment . Provides education for HEDIS measures, appropriate medical… more
- CVS Health (Hartford, CT)
- …this dynamic business that could be aligned with membership, revenue, SG&A and risk adjustment . You will collaborate with stakeholders to align financial goals ... example functions include Finance, Actuarial, Product and Pricing, Network, Risk Adjustment Operations. + Manage senior stakeholders...and source of variations in P&L against forecast, across risk adjusted revenue and cost (eg, claims … more