- Unknown (Rancho Cucamonga, CA)
- …across multiple product lines. The role demands expert knowledge of Medicare Advantage , Medi-Cal, and ACA risk adjustment methodologies and regulations, ... Vice President of Risk Adjustment About the Company Prominent...Specialties hmo healthcare insurance managed care medicaid medi-cal and medicare About the Role The Company is seeking a… more
- Unknown (Nashville, TN)
- …$1-$5 million Specialties annual wellness visit healthcare it software saas risk adjustment healthcare coding and medicare advantage About the Role The ... health plan business, with a focus on exceeding sales goals for risk adjustment and platform solutions. The successful candidate will be responsible for managing… more
- Unknown (Houston, TX)
- …years' progressive leadership experience in healthcare operations, with at least 3 years in Medicare Advantage , global risk , and delegated MSO settings, is ... and encounter data integrity, quality/STARs performance improvement, and revenue cycle management/ risk adjustment . Strong financial acumen, proven success in… 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 ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...CPT (II), and HCPCS coding systems + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Specialist, you will be responsible for: + Serving as a Subject Matter ... Expert (SME) for risk adjustment with contracted IPAs + Collaborating...of health plan experience, highly desired + Knowledge of Medicare Advantage , STARS/HEDIS program, and NCQA technical… 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
- 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)
- …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 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
- Datavant (Honolulu, HI)
- …with the teams to improve productivity and quality.** + Run various risk adjustment models for Medicare Advantage , Medicaid or ACA to forecast patient ... and life experiences to realize our bold vision for healthcare. The Risk Adjustment Sr Data Analyst is an experienced analyst possessing a deep understanding… more
- Molina Healthcare (Roswell, NM)
- …and development ad-hoc as well as automated analytical modules related to Risk Adjustment for Medicaid, Marketplace and Medicare /MMP. + Assist Risk ... **Job Description** **Job Summary** The Lead, Risk Adjustment - Predictive Analytics role...like Python and R programming would be an added advantage . + 5+ Years of experience in Analysis related… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Principal Risk Adjustment Healthcare Analyst Location: Hybrid | Eagan, Minnesota Career ... Cross and Blue Shield of Minnesota is hiring a Principal Healthcare Analyst on our Risk Adjustment team in Eagan, MN.The Principal Healthcare Analyst - Risk … 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
- Amazon (San Francisco, CA)
- …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
- 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
- Emanate Health (Covina, CA)
- …and billing staff to ensure accurate documentation, coding compliance, and optimal risk adjustment outcomes. The HCC Coding Specialist ensures the IPA's ... Risk Adjustment Factor (RAF) maintains or exceeds...data analysis, reporting, and presentation development. Experience working with Medicare Advantage . Ability to interpret medical records… more
- Highmark Health (Cheyenne, WY)
- …and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team… more
- Corewell Health (Grand Rapids, MI)
- We are seeking a highly analytical and detail-oriented Risk Adjustment Reporting Developer to support our organization's Medicare Advantage , ACO, ACA, ... BIDs, Data Engineers, Data Scientists, and internal/external customers. Essential Functions + Risk Adjustment Analytics & Reporting + Develop and deliver… more
- UCLA Health (Los Angeles, CA)
- …Triennial Review, pre-delegation reviews, and more. * Design and improve audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with ... our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug...D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance… more
- Humana (Tallahassee, FL)
- …innovator, and relationship builder, ensuring alignment with Humana's mission and Medicare Advantage goals. **Primary Responsibilities:** Clinical Engagement & ... understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
