- Elevance Health (St. Louis, MO)
- …performs very complex actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + Analyzes ... would provide an equivalent background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience… 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 specifications, a… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , 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 plan. You will: + Conduct medical record… more
- Elevance Health (Atlanta, GA)
- …program areas including but not limited to: claims, grievances and appeals, Part D and risk adjustment . + Knowledge of Risk Adjustment Payment ... methodologies and the CMS HCC Model. + Healthcare operations and/or compliance experience within a large payor organization. + Progressive experience working with senior leadership and collaborating across businesses in a highly matrixed healthcare… more
- The Cigna Group (Houston, TX)
- …and around coverage area.** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned ... matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise in ICD-10-CM/outpatient and… more
- MedKoder (Mandeville, LA)
- …(recent hands-on production). Must have at least 1 year of specialized experience in Medicare Risk Adjustment disciplines- such as HCC, CCC HEDIS + ... Auditing experience a PLUS. ICD-10 experience/education a PLUS. About MedKoder, LLC: * Privately held, growing company with strong values and ethics * Professional development and education * All positions are permanent - no contracts or sitting on a "coding… more
- Providence (WA)
- …for our Medicare Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical ... **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:** + Be responsible for developing...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- Humana (Nashville, TN)
- …+ Maintains collaborative relationships with internal partners (Provider Engagement, Finance, Medicare Risk Adjustment , Interoperability, Clinical Team, ... groups and influencing execution of recommended strategy + Experience with Medicare Risk Adjustment and/or medical coding + Understanding of Consumer/Patient… more
- CVS Health (Overland Park, KS)
- …Medicare Advantage, MSSP, ACO REACH).** **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk ... (MSSP and ACO REACH), including but not limited to risk adjustment opportunities, HCC gaps, and benchmarking...Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis -Excellent oral &… more
- CVS Health (Blue Bell, PA)
- …position in the financial organization that conducts member eligibility verifications within the Medicare Risk Adjustment Team. Verification's are made via ... Financial reporting and analysis/1-3 Years. **Preferred Qualifications** Background in MSP ( Medicare Secondary Payer) or COB (Coordination of Benefits). Medicare … more
- Atlantic Health System (Morristown, NJ)
- …of mandatory Organized Delivery System filings + Responsibility for supplemental submission of Medicare Risk Adjustment Files associated with Medicare ... performance across payer lines of business + Engage in assessments of MSSP - Medicare Shared Savings Program participation as required by the ACOs. + Communicate and… more
- UPMC (Pittsburgh, PA)
- …and inform strategies that affect alignment of CHC and the D-SNP alongside Medicare Product, Risk Adjustment , Finance, Sales and Marketing, Operations, ... administrative authority to provide health coverage for dually eligible (Medicaid and Medicare ) beneficiaries in an integrated and effective manner. This is a highly… more
- Covenant Health Inc. (Knoxville, TN)
- …assist in care coordination efforts. + Demonstrates knowledge of HEDIS, HCCs, and Medicare Risk Adjustment and their impact on pay-per-performance contracts. ... + Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested. + Performs other duties as assigned.… more
- Covenant Health Inc. (Knoxville, TN)
- …assist in care coordination efforts. + Demonstrates knowledge of HEDIS, HCC's and Medicare Risk Adjustment and their impact on pay-per-performance contracts. ... + Perform other duties as assigned or requested. Qualifications Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.… more
- CVS Health (Woonsocket, RI)
- …knowledge of Value Based Contracting** **Strong knowledge of ACOs** **Deep experience with Medicare Advantage VBC models** ** Risk Adjustment experience will ... Care organization. We contract directly with CMS on full risk model for the Medicare Fee For...the AC business which includes client implementations, vendor management, risk adjustment , the informatics and interoperability strategy**… 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
- Point32Health (Canton, MA)
- …and Operations, this individual will support the operations and analysis of risk adjustment strategy across Point32Health business lines. The Data Analyst ... will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and synthesizing results to develop… more
- TEKsystems (Minneapolis, MN)
- …Centers for Medicare & Medicaid Services) rules and regulations for Risk Adjustment submissions, along with strong knowledge and understanding of claims, ... the team's current focus is on meeting the January deadline. Role: Enterprise Risk Adjustment Submissions Analyst, Sr The Government Programs Enterprise Risk… more
- CenterWell (Tallahassee, FL)
- …administration, or related field + Well-versed in various reimbursement methodologies, including risk adjustment , fee for service, Medicare , etc. + ... and help us put health first** The Associate Director, Risk Adjustment oversees quality assurance audits of...HCPCS codes that are submitted to the Centers for Medicare and Medicaid Services (CMS), other payers, and over… more
- The Cigna Group (Sunrise, FL)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage requiredAbility ... on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. + Schedules, prepares for and… more