- The Cigna Group (Chattanooga, TN)
- …**Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in an operational ... of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It...health plan coding initiatives guidelines and requirements of the Risk Adjustment program to ensure… 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 ... Adjustment Data Validation Audits required. Strong knowledge of Medicare Risk Adjustment regulations required....for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… more
- The Cigna Group (Bloomfield, CT)
- …team is responsible for developing solution changes for the ongoing needs of CMS Medicare Risk Adjustment processes and systems. The ** Medicare ... Office]** We have an immediate need to strengthen our Risk Adjustment and Stars Enablement team. The...for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and ... the Quality Program to implement tactics for risk adjustment optimization, particularly for provider and...experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions.… more
- 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
- Fallon Health (Worcester, MA)
- …and report on FCHP patient charts for the purpose of validating regulatory Risk Adjustment scores. The Chart Review Specialist will collect diagnostic details ... documentation feedback and submit to Manager for provider education efforts + Update risk adjustment software with all relevant chart review observations + Meet… more
- The Cigna Group (Denver, CO)
- **Summary** The Medicare Risk Adjustment Advanced Analytics team is searching for a highly motivated and collaborative person to build new data processes, ... analytics. You will work closely with colleagues across the Risk Adjustment business, data science, and data...for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… more
- Health First (Rockledge, FL)
- … Risk Adjustment Associates in order to increase awareness of the significance of Medicare Risk Adjustment (MRA) within the CMS Risk Adjustment ... *POSITION SUMMARY * Contribute to Health First Health Plans Risk Adjustment activities that support compliance with regulatory and contractual requirements… more
- Martin's Point Health Care (Portland, ME)
- …Ideal candidates are those who are coming from a Health Plan and with strong Risk Adjustment and Medicare backgrounds. Job Description 100Key Outcomes: + ... Work" since 2015. Position Summary The Vice President of Risk Adjustment works closely and collaboratively with...Develops and maintains an expert level of knowledge of Medicare and risk -based reimbursement methodologies. + Operational… more
- CVS Health (New Albany, OH)
- …+ Strong written and verbal communication. **Preferred Qualifications** + Risk adjustment program experience within Medicare . **Education** + Bachelor's ... opportunity for a Program Manager to join our Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP lines of business! In this… 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
- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality ... of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert...MHI RQES and VP Stars in developing the local Medicare Stars work plan and executes on interventions that… more
- Molina Healthcare (Owensboro, KY)
- **JOB DESCRIPTION** **Job Summary** Responsible for retrospective risk adjustment programs involving department or cross-functional teams of subject matter ... Owners of supporting IT systems. **Job Duties** + Oversee all retrospective risk adjustment programming and provide insightful reporting on trends,… more
- The Cigna Group (Philadelphia, PA)
- …analytics + Strong familiarity with medical claims data + Experience with HHS ACA (or Medicare ) risk adjustment model + Strong database manipulation and SQL ... IFP Analytics team responsible for identifying and sizing new risk adjustment opportunities that not only create...for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… more
- Banner Health (Phoenix, AZ)
- …and develops clinical strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of our MA, MSSP, Medicaid, ... this position may be eligible for our Management Incentive Program as part of your Total Rewards package. Banner...as the clinical DYAD to the Executive Director of Risk Adjustment , co-leading a robust team that… more
- Sutter Health (Sacramento, CA)
- … program management in a healthcare or health plan setting. + Knowledge of risk adjustment program management. + Knowledge of health plan regulatory and ... **Organization:** Sutter Health Plan - Valley **Position Overview:** As a program management expert, the incumbent will develop, manage, and execute regulatory 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 + ... completion of at least one AHIMA or AAPC certified program with the achievement of the correlating professional credential...Profit Sharing * STD, LTD, Life Insurance, and FSA Program * Paid AAPC and AHIMA corporate memberships *… more
- Centene Corporation (Tallahassee, FL)
- …care experience preferred. + Experience driving quality, finance, risk adjustment , network/provider, and growth initiatives with Medicare product in the ... requirements and meet business needs and strategic objectives. + Support Medicare business department initiatives that promote, quality, network safety and cost… more
- The Cigna Group (Baltimore, MD)
- …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
- The Cigna Group (Denver, CO)
- …on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. + Schedules, prepares for and ... including but not limited to Health Services, Medical Economics, Sales, and Stars & Risk Adjustment in order to develop solutions for strategic business needs +… more