- CVS Health (Columbus, OH)
- …for an enthusiastic team player to lead a suite of market focused Risk Adjustment Programs for a portfolio of Aetna Better Health Medicaid Plans. Reporting to the ... Lead Director of Medicaid Risk Adjustment , the Market Manager will work closely with cross-functional...This position will require a comprehensive understanding of risk adjustment , with the ability to speak to and present… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of key risk ... adjustment performance metrics through coordination of analytical processes, investigation...to solve problems, provide data-driven guidance, and monitor risk adjustment performance. Provide analytical support on various strategies to… more
- UCLA Health (Los Angeles, CA)
- …this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is instrumental in ... of key performance indicators to enable operational excellence within the risk adjustment department. You will be responsible for coordinating mock RADV audits and… 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 with IPAs on risk adjustment strategies to achieve health plan goals and KPIs + Presenting and managing all… more
- CVS Health (New Albany, OH)
- …Aetna has an exciting opportunity for a Program Manager to join our Risk Adjustment Retrospective Program for ACA, Medicare, MMP and DSNP lines of business! In this ... will serve as a hybrid project manager and subject matter expert in Risk Adjustment chart retrieval & coding programs and related analytics and reporting. Your will… more
- ChenMed (Miami, FL)
- …rapidly expanding and we need great people to join our team. The Risk Adjustment Coder works in a collaborative effort directly with physicians and their office ... to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A major focus of the… more
- Centene Corporation (Tallahassee, FL)
- …audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis ... market level. + Subject matter experts for proper risk adjustment coding and CMS data validation + Work in...providers. + Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and… more
- Point32Health (Canton, MA)
- …be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD), including submissions to CMS and state agencies. The ... of production issues pertaining to state government and risk adjustment data submissions, including issue investigation, business requirements, user acceptance… more
- Highmark Health (Pittsburgh, PA)
- …job provides end-to-end management, delivery and support to new and existing Risk Adjustment Programs. The incumbent will deliver value to the Health Plan, and its ... and achieve strategic objectives relative to new and existing Risk Adjustment Programs. Supports other key objectives designed to build/strengthen patient care… 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 audits for… more
- Baylor Scott & White Health (Columbus, OH)
- …maximize risk scoring in keeping with Baylor Scott and White Health risk adjustment strategies and processes for lines of business subject to risk adjustment ... provider audits and creates provider scorecards to offer feedback on Risk Adjustment Methodology + Interprets health record documentation to code and abstracts… more
- Centene Corporation (Phoenix, AZ)
- …Tempe and Tucson, Arizona visiting Providers. **Position Purpose:** Utilize risk adjustment methodologies, principles, and knowledge of managed care organizations to ... Develop collaborative relationships with providers to educate and improve Risk Adjustment coding and documentation competencies. + Use knowledge of ICD10 guidelines… more
- ChenMed (Miami, FL)
- …expanding and we need great people to join our team. The Risk Adjustment Auditor works in a collaborative effort directly with physicians, their office staff, ... ensure that medical documentation and supportive evidence complies with risk adjustment initiatives, improving revenue cycle and denial of payments. **ESSENTIAL JOB… more
- Medical Mutual of Ohio (OH)
- …and individual plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance, and other corporate ... of provider agreements.** + **Acts as project manager over large internal risk adjustment projects (eg, Optum In Office Assessment program for both MA and ACA,… more
- HSBC (New York, NY)
- …areas eg credit risk, counterparty credit risk, securitization, and Credit Valuation Adjustment ('CVA'). GRPA currently maintains a presence in key locations across ... with a focus on providing policy guidance on the new Credit Valuation Adjustment ('CVA') capital requirements within the US Agencies' proposed adoption of the 'Basel… more
- City of New York (New York, NY)
- …Supervisor for the Account Auditing, Account Maintenance, Accounting and Payment Adjustment units, with some latitude for independent action, the Account Specialist ... recruit seven (7) Bookkeeper II's to function as Account Adjustment Adjusters who will: - Respond verbally and in...batch transactions to reconcile balances, updates account remarks if adjustment to the account occurred, and records case remarks… more
- Centene Corporation (Columbia, SC)
- …and has a complete understanding of these guidelines. + Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines. + Understands ... the impact of ICD-10 codes on the CMS HCC risk adjustment model. + Ability to meet productivity and accuracy standards + Ability to defend coding decisions to both… more
- Elevance Health (Norfolk, VA)
- **Risk Adjustment Advanced Analyst Senior** **Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of ... one of our Elevance Health PulsePoint locations.** The **Risk Adjustment Advanced Analyst Senior** is responsible for creating statistical models to predict,… more
- Bank of America (Greensboro, NC)
- Research and Adjustment Representative II Greensboro, North Carolina **Job Description:** **Work Schedule: Monday - Friday (8:00 AM to 5:00 PM)** At Bank of America, ... **Job Description:** This job is responsible for resolving research and adjustment inquiries within the bank's practices and procedures. Key responsibilities include… more
- Trane Technologies (Davidson, NC)
- …us in boldly challenging what's possible for a sustainable world. The Tax Adjustment Analyst is responsible for sales tax determination on equipment, service, local ... buy-sell, and parts sales and purchases. Participate on a team that is responsible for accurate sales tax billing for the Trane Technologies North America region. Successful candidate is preferred to have had previous experience with US sales and use tax and… more
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