• Director of Medicare Risk

    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 ... 50 miles of our Elevance Health PulsePoint locations. The **Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for planning,… more
    Elevance Health (11/21/24)
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  • Actuarial Analyst III - Medicare

    Elevance Health (St. Louis, MO)
    …performs very complex actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + Analyzes ... would provide an equivalent background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience… more
    Elevance Health (10/30/24)
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  • Medicare Advantage Risk

    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 (10/25/24)
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  • Clinical Documentation Integrity Specialist…

    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 (11/11/24)
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  • Medicare Risk Adjustment

    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
    Elevance Health (11/21/24)
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  • Staff VP Compliance Medicare Operations…

    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 ... methodologies and the CMS HCC Model. + Healthcare operations and/or compliance experience within a large payor organization. + Progressive experience working with senior leadership and collaborating across businesses in a highly matrixed healthcare… more
    Elevance Health (11/06/24)
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  • Risk Adjustment Provider Educator…

    The Cigna Group (Houston, TX)
    …and around coverage area.** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned ... matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It will require expertise in ICD-10-CM/outpatient and… more
    The Cigna Group (11/14/24)
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  • HCC Risk Adjustment Coder

    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
    MedKoder (10/16/24)
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  • Senior Actuarial Analyst, Medicare Bid…

    Providence (WA)
    …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
    Providence (10/31/24)
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  • RN Senior Stars Improvement, Clinical Consultant

    Humana (Nashville, TN)
    …+ Maintains collaborative relationships with internal partners (Provider Engagement, Finance, Medicare Risk Adjustment , Interoperability, Clinical Team, ... groups and influencing execution of recommended strategy + Experience with Medicare Risk Adjustment and/or medical coding + Understanding of Consumer/Patient… more
    Humana (11/13/24)
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  • Actuary - Accountable Care

    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 (11/02/24)
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  • Value Based Program Manager

    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
    Atlantic Health System (10/29/24)
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  • VP, Managed Long-Term Services and Supports

    UPMC (Pittsburgh, PA)
    …and inform strategies that affect alignment of CHC and the D-SNP alongside Medicare Product, Risk Adjustment , Finance, Sales and Marketing, Operations, ... administrative authority to provide health coverage for dually eligible (Medicaid and Medicare ) beneficiaries in an integrated and effective manner. This is a highly… more
    UPMC (11/09/24)
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  • Medical Records Coder- Remote- Cigna Healthcare

    The Cigna Group (Bloomfield, CT)
    …physician-specific regulations and polices related to documentation and coding. Knowledgeable of Medicare Risk Adjustment . Proficiency with ICD-10-CM coding ... and guidelines. Must be detail oriented, self motivated, and have excellent organization skills. Candidate must possess and maintain one of the following certifications issued by American Health Information Management Association (AHIMA) or American Academy of… more
    The Cigna Group (11/22/24)
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  • Care Navigator

    Covenant Health Inc. (Knoxville, TN)
    …assist in care coordination efforts. + Demonstrates knowledge of HEDIS, HCCs, and Medicare Risk Adjustment and their impact on pay-per-performance contracts. ... + Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested. + Performs other duties as assigned.… more
    Covenant Health Inc. (11/16/24)
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  • RN Care Coordinator

    Covenant Health Inc. (Knoxville, TN)
    …assist in care coordination efforts. + Demonstrates knowledge of HEDIS, HCC's and Medicare Risk Adjustment and their impact on pay-per-performance contracts. ... + Perform other duties as assigned or requested. Qualifications Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.… more
    Covenant Health Inc. (10/23/24)
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  • Risk Adjustment Analyst

    VNS Health (Manhattan, NY)
    OverviewSupports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk ... industry resources to increase knowledge and improve return on investment (ROI) of risk adjustment activities. Understands risk adjustment models… more
    VNS Health (10/03/24)
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  • Sr. Data Analyst, Risk Adjustment

    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
    Point32Health (11/16/24)
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  • Risk Adjustment Submissions Analyst…

    TEKsystems (Minneapolis, MN)
    …Centers for Medicare & Medicaid Services) rules and regulations for Risk Adjustment submissions, along with strong knowledge and understanding of claims, ... the team's current focus is on meeting the January deadline. Role: Enterprise Risk Adjustment Submissions Analyst, Sr The Government Programs Enterprise Risk more
    TEKsystems (11/12/24)
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  • Associate Director, Risk Adjustment

    CenterWell (Tallahassee, FL)
    …administration, or related field + Well-versed in various reimbursement methodologies, including risk adjustment , fee for service, Medicare , etc. + ... and help us put health first** The Associate Director, Risk Adjustment oversees quality assurance audits of...HCPCS codes that are submitted to the Centers for Medicare and Medicaid Services (CMS), other payers, and over… more
    CenterWell (10/30/24)
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