- Highmark Health (Columbus, OH)
- …requires the incumbent to: + **Lead and manage a team of interoperability and risk adjustment SMEs:** Provide guidance, mentorship, and support to team members, ... ensuring accurate and timely data flow across systems. + **Oversee risk adjustment processes and ensure compliance with regulations:** Stay abreast of evolving… more
- Highmark Health (Pittsburgh, PA)
- …This job provides end-to-end management, delivery and support to new and existing Risk Adjustment Programs. The incumbent will deliver value to the Health ... business outcomes and achieve strategic objectives relative to new and existing Risk Adjustment Programs. Supports other key objectives designed to… more
- System One (Houston, TX)
- …responsible for risk score tracking and improvement. + Maintains internal risk adjustment models using published documentation. + Manages projects, including ... large health insurance organization that is seeking a qualified Manager level candidate to oversee their Data Risk...years management experience strongly preferred. + Experience with various risk adjustment models including the CMS Medicare… more
- Molina Healthcare (NM)
- …-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 requirements, QA/validation checks, report design) + -Technical skills (SQL, Excel, Power BI, Tableau)… more
- Elevance Health (Richmond, VA)
- **Title: Manager Government Business other revenue programs ( Manager Risk Adjustment Quality Control)** **Location: Chicago IL, Indianapolis IN, Grand ... management experience in a managed care setting with extensive risk adjustment experience with a focus on...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- The Cigna Group (Houston, TX)
- …business needs. The role will work under the direction of Risk Adjustment & Stars Provider Education Regional Manager in conjunction with matrix partners. ... ** Risk Adjustment Provider Educator - Houston**...** Risk Adjustment Provider Educator - Houston** **Must reside in...**Core Responsibilities:** + In partnership with Risk Adjustment & Stars Provider Education Regional Manager ,… 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
- Elevance Health (Atlanta, GA)
- **Business Change Director- Risk Adjustment Data Quality** **Location:** This position will work a hybrid model (remote and office). Ideal candidates must live ... of a PulsePoint location. The **Business Change Director for Risk Adjustment Data Quality** will serve as...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CenterWell (Tallahassee, FL)
- …our caring community and help us put health first** The Associate Director, Risk Adjustment oversees quality assurance audits of medical records, ICD-10-CM, CPT, ... other payers, and over government agencies. In addition, the Associate Director, Risk Adjustment oversees all medical coding education activities. The Associate… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …with Premera Medical Directors and Provider Network Executives, the **Quality and Risk Adjustment - Provider Clinical Consultant (PCC)** works directly with ... adequate training is available for documentation and coding best practices for HEDIS and risk adjustment . This role will have a positive impact on our clinical… more
- Elevance Health (Columbus, OH)
- **Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... 50 miles of our Elevance Health PulsePoint locations. The **Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for planning, directing… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** **Description:** **CERTIFIED RISK ADJUSTMENT CODING SPECIALIST** **Location:** Trinity Health PACE Corp Michigan ... client care documentation for billing. + Monitors and informs manager of records that are not completed timely. Monitors,...+ Must be certified or obtaining certification for Certified Risk Adjustment Coder thru AAPC. If not… more
- Elevance Health (St. Louis, MO)
- …actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + Analyzes and implements risk ... background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience is strongly preferred. Please be… 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 ... objectives. + Collaborates with management to set strategic vision; oversees manager (s)/director(s) with direct reports. + Hires, trains, coaches, counsels, and… 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 our Elevance Health PulsePoint locations.** **Preferred Location: Norfolk, VA.** The ** Risk Adjustment Advanced Analyst Senior** is responsible for creating… more
- HSBC (New York, NY)
- …all relevant risk areas eg credit risk , counterparty credit risk , securitization, and Credit Valuation Adjustment ('CVA'). GRPA currently maintains a ... establishment of interpretations and governance processes to mitigate regulatory risk . GRPA also monitors new rule developments and other...City area may be considered. As our Regulatory Policy Manager - Credit Valuation Adjustment you will:… more
- CVS Health (Houston, TX)
- …has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role you will provide complex analytics ... and reporting to support Medicaid Risk Adjustment to address business questions regarding population health management, health and economic outcomes, and other… more
- Principal Service Solutions (De Soto, KS)
- …manipulation, retrieval, and report creation and submission to System Engineer, Project Manager and Service/ Installation Manager . + Monitor, guide and train ... all times. + The employee is occasionally exposed to toxic or caustic chemicals and risk of electrical shock. + The noise level in the work environment is usually… more
- Molina Healthcare (UT)
- …(RQS) team by overseeing large programs and multiple projects supporting Molina's Risk Adjustment and Quality performance. This position collaborates with ... **Job Description** **Job Summary** The Lead Risk and Quality Performance Manager supports...6+ years of program and/or project management experience in risk adjustment and/or quality * 6+ years… more
- Molina Healthcare (NE)
- …SKILLS & ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of experience supporting HEDIS ... **Job Description** **Job Summary** The Risk & Quality Performance Manager position...engine activity, risk adjustment targeting and reporting systems *… more
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