- CareSource (Dayton, OH)
- …using pricing models related to Medicare Advantage Experience with Medicare Risk Adjustment Experience with building large Excel models Proficient ... MLR results Performs other duties as assigned Preferred Experience: Experience with Medicare Advantage bids Experience with data compilation to support bids… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- The ** Risk Adjustment & Quality Division at BCBST** is seeking a skilled ** Risk Adjustment Medical Record Coder** to support our mission of delivering ... per week in accordance with BCBST policy\. **Preferred Qualifications:** + CRC \(Certified Risk Adjustment Coder\) certification is a plus\. If not currently… more
- UnitedHealth Group (Hopkinsville, KY)
- …providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance ... programs focused on improving the quality of care for Medicare Advantage Members. Will be out in...diagnosis coding Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the… more
- Johns Hopkins University (Baltimore, MD)
- …operation of health insurance and managed care programs, including Medicaid and Medicare Advantage . Deep understanding of the regulatory environment for managed ... such as claims processing, premium billing, encounter data, utilization management, risk adjustment , provider contracting, quality metrics, and related… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … Adjustment Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), ... military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk… more
- Elevance Health (West Des Moines, IA)
- …limited to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data ... performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …company seeks a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this ... you will drive the strategic planning, development, and optimization of our Medicare Advantage Risk Adjustment solution, ensuring that our deliverables… more
- CareFirst (Baltimore, MD)
- …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...supports the execution of the corporate coding strategy across Medicare Advantage , Medicaid, and ACA markets. This… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk adjustment ... strategy. The role serves as a dedicated resource within the organization for Medicare Advantage , Medicaid and ACA markets, coordinating and leading the end to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of...and problem resolution to meet business operational requirements for Medicare Advantage (MA), Affordable Care Act (ACA) &… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …your knowledge of risk adjustment and healthcare data (primarily Medicare Advantage , Medicaid, and ACA Commercial), looking for trends within data and ... stakeholders across the enterprise. The ideal candidate will have experience with risk adjustment , Medicare Advantage , Medicaid, ACA commercial, clinical… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Quality & Risk Adjustment Provider Consultant Location: Hybrid | Eagan, Minnesota Career ... * Knowledge of Health Care Quality measures * Certified Risk Adjustment Coder (CRC via AAPC) or...Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay… more
- Humana (Harrisburg, PA)
- …This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the expansion and support for ... focused in the areas of Provider Contracting, Provider Engagement and Quality, Risk Adjustment , Clinical, and Financial Operations. + Leadership development,… more
- Blue KC (Kansas City, MO)
- …groups. + Analyze data and monitor provider metrics to identify risk adjustment , HEDIS or educational opportunities for the Medicare Advantage and ... programs focused on improving the quality of care for Medicare Advantage & Qualified Health Plan (ACA)...business. + Develop educational tools for network providers regarding risk adjustment and HEDIS documentation and coding… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …for the execution and day-to-day management of data submissions for ACA Commercial, Medicare , and Medicaid risk adjustment and quality programs. * ... team responsible for maintaining, executing, and evaluating initiative impacts using the risk adjustment and quality analytics models across ACA Commercial, … more
- University of Michigan (Ann Arbor, MI)
- …impact of insurer-practice integration on patient access and quality. **2. Upcoding and risk adjustment in Medicare Accountable Care Organizations (ACOs)** ... are targeting primary care practices serving older adults in Medicare Advantage (MA), acquiring or contracting with...expected health risk a process known as risk adjustment . Yet this system can be… more
- Amazon (New York, NY)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... TME performance compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data primarily -Medical… more
- Amazon (IL)
- …current on CPT, ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance. Assign appropriate ICD-10-CM, CPT, and other relevant ... requests in a timely manner. Work collaboratively with the Medicare Risk Operations team to ensure positive...a Profee Coder in an office setting inclusive of risk adjustment coder experience required * 1+… more
- Humana (Fort Lauderdale, FL)
- …+ Experience with public speaking and presentation skills with healthcare providers + Medicare Risk Adjustment knowledge **Additional Information** Work at ... 4 or more years of medical coding experience + Risk Adjustment knowledge + Proficiency with data...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …providing needed data and reporting, and partner with actuaries to resolve related risk adjustment issues. The ideal candidate will have experience with ... Encounter Data, Medicare Advantage , Medicaid, ACA commercial, and clinical...BI, and will have experience partnering with actuaries on risk adjustment issues. Your Responsibilities * Performs… more
