- 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… 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...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage, STARS/HEDIS program, and NCQA technical specifications, a… more
- UCLA Health (Los Angeles, CA)
- …direction. You can do all 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 participating in the planning with...key performance indicators to enable operational excellence within the risk adjustment department. You will be responsible… more
- VNS Health (Manhattan, NY)
- …to CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers ... evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC… more
- Martin's Point Health Care (NY)
- …Actuarial Sciences, or other quantitative discipline; Master's degree preferred. 5 years Medicare risk adjustment analytic experience with Bachelor's degree ... a "Great Place to Work" since 2015. Position Summary The Risk Adjustment Reporting and Data Analystanalyzes data, reviews findings, and develops recommendations… 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 + ... Auditing experience a PLUS. ICD-10 experience/education a PLUS. About MedKoder, LLC: * Privately held, growing company with strong values and ethics * Professional development and education * All positions are permanent - no contracts or sitting on a "coding… more
- Providence (OR)
- …for our Medicare Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical ... **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:** + Be responsible for developing...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- Healthfirst (NY)
- … and Medicaid Services (CMS) practices, policies, and regulations. Expert knowledge of Medicare Risk Adjustment Payment Methodology, HCC, CRG and other ... leadership to analysts and staff in support of all processes related to risk adjustment for Medicaid, Medicare & QHP products. + Direct the communication… more
- Henry Ford Health System (Troy, MI)
- …audits including but not limited to coordination, documentation and coding of CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) and ... of computer software programs used for data collection. + Knowledge of Medicare Advantage risk adjustment payment methodology preferred. + Knowledge of CMS… more
- VNS Health (Manhattan, NY)
- …records, including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required + 2 years of experience in ... areas of opportunity to support accuracy clinical documentation. Works with Risk Adjustment and Quality team to identify topics, areas and opportunities for… more
- Henry Ford Health System (Troy, MI)
- …and vendor-driven projects. Become proficient using the Altegra RiskView systems for both Medicare Advantage Risk Adjustment and Healthcare Reform Risk ... but not limited to coordination, documentation, and coding of CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) and vendor service project… more
- AdventHealth (Altamonte Springs, FL)
- …summarizing and trending all aspects of Medicare business, CMS Revenue, Enrollment, Risk Adjustment , cost trend, and quality + Serve as the liaison between ... against the data warehouse to derive insights on medical cost opportunities, risk adjustment accuracy opportunities, quality opportunities, and overall financial… more
- Hartford HealthCare (Farmington, CT)
- …documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the ... and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. Reporting… more
- CVS Health (Richmond, VA)
- …are seeking a highly skilled and motivated Senior Analyst, Informatics to join our expanding Medicare risk adjustment analytics team. In this role, you will ... analytics processes. **Preferred Qualifications** + Prior experience in healthcare analytics, risk adjustment , HEDIS, claims/EHR and other care management data.… more
- Humana (Columbus, OH)
- …regarding job duties + Ability to work under minimal supervision **Preferred** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in ... Quality Reporting and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical...Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… more
- Humana (Columbus, OH)
- …data requires an in-depth evaluation of variable factors **Preferred Qualifications** + Experience in Medicare Advantage - risk adjustment or Stars + Degree ... Quality Reporting and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical...Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… more
- Molina Healthcare (Milwaukee, WI)
- …plan products to coordinate a medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills ... examination. + Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . + Conduct comprehensive annual medication reviews… more
- CVS Health (Overland Park, KS)
- …Medicare Advantage, MSSP, ACO REACH).** **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk ... (MSSP and ACO REACH), including but not limited to risk adjustment opportunities, HCC gaps, and benchmarking...Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis -Excellent oral &… more
- CVS Health (Blue Bell, PA)
- …position in the financial organization that conducts member eligibility verifications within the Medicare Risk Adjustment Team. Verification's are made via ... Financial reporting and analysis/1-3 Years. **Preferred Qualifications** Background in MSP ( Medicare Secondary Payer) or COB (Coordination of Benefits). Medicare … more
- Atlantic Health System (Morristown, NJ)
- …of mandatory Organized Delivery System filings + Responsibility for supplemental submission of Medicare Risk Adjustment Files associated with Medicare ... performance across payer lines of business + Engage in assessments of MSSP - Medicare Shared Savings Program participation as required by the ACOs. + Communicate and… more
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