- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor, you will be an expert in risk adjustment coding ... 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 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...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage , STARS/HEDIS program, and NCQA technical… more
- Somatus (Mclean, VA)
- …5 years of leadership/management experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven ... well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and… more
- Elevance Health (St. Louis, MO)
- …and performs very complex actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + ... an equivalent background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience is strongly… more
- Providence (WA)
- … Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical background + ... providing critical insights to enhance the performance of our Medicare Advantage plans **_Please note the following...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- The Cigna Group (Nashville, TN)
- …and judgement when completing deliverables. + Develops and maintains an advanced knowledge of Medicare Advantage risk adjustment and can articulate ... risk adjustment strategy. Reporting to the Medicare Advantage Revenue Finance lead, this position...Prefer candidates with some familiarity of Medicare Advantage and risk adjustment . +… more
- The Cigna Group (Bloomfield, CT)
- …and initiatives in collaboration with matrix partners with a focus on Medicare Advantage Stars and Risk Adjustment lenses. + Develop and execute of ... action using data-driven analyses + Strong knowledge of Medicare Advantage Stars and Risk Adjustment business needs + Experience with electronic health… more
- Providence (Beaverton, OR)
- …we must empower them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform ... coding audits of Hhierarchical Condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors + Perform audits to ensure compliance… more
- The Cigna Group (Bluffton, SC)
- …audit. **Qualifications:** Bachelor's degree or equivalent. **5+ years of experience with Medicare Risk Adjustment -is required.** 5+ years of experience ... working with Medicare Advantage , Medicare -Medicaid. Plan (Dual-Eligible) and/or Medicaid. **Certified...Adjustment Data Validation Audits required. Strong knowledge of Medicare Risk Adjustment regulations required.… more
- Health First (Rockledge, FL)
- *POSITION SUMMARY* This role contributes to Health First Health Plans' (HFHP) Risk Adjustment data collection, supporting compliance with regulatory and ... business. This individual will ensure the integrity of HFHP risk adjustment data by critically analyzing and...Microsoft Access preferred. o Knowledge and understanding of Federal Medicare program, Medicare Advantage Plans,… 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 ... increase knowledge and improve return on investment (ROI) of risk adjustment activities. Understands risk ...experience in a healthcare setting required + Knowledge of Medicare Advantage required + Familiarity with medical… more
- The Cigna Group (Seattle, WA)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage ... but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. +...members contribute to the growth and profitability of the Medicare Advantage business in their market in… more
- The Cigna Group (Atlanta, GA)
- …(which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, Provider Relations, and ... and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance...members contribute to the growth and profitability of the Medicare Advantage business in their market in… more
- CVS Health (Blue Bell, PA)
- …root-cause analyses, and manage the risk position of various value-based products ( Medicare Advantage , MSSP, ACO REACH).** **What will you do?** + Evaluate ... the impact of Medicare quality and risk adjustment ...-ASA or close to ASA required -Strong knowledge of Medicare Advantage products, ACO, MSSP, ACO REACH… more
- VNS Health (Manhattan, NY)
- OverviewVNS Health Medicare Advantage experiences accelerated year-over-year growth, doubling membership in the last 12 months. We continue to strengthen our ... making that drives results. As the Supervisor, Actuary for Medicare Advantage (MA), you will play a...accurate decision-making. + Provides data and analytical support to Risk Adjustment team, Care Management and other… more
- Humana (Columbus, OH)
- …the impact on underwriting margin. They will work collaboratively with peers across Medicare Risk Adjustment , Membership Growth Analytics, Medicare ... reporting & analysis, reserving or trending) + Experience in Medicare Advantage pricing, analytics, or forecasting **Preferred...with member cohort/segmentation, Medicare Membership Report (MMR), Medicare Risk Adjustment (MRA), or… more
- LA Care Health Plan (Los Angeles, CA)
- …Product: Required: 5+ Commercial annual rate setting experience 5+ Commercial risk adjustment experience 8+ year of leading large-scale cross-functional ... Medicare and Medicaid Services (CMS) annual rate setting experience CMS risk adjustment experience 8+ year of leading large-scale cross-functional initiatives… more