- The Cigna Group (Bloomfield, CT)
- …team is responsible for developing solution changes for the ongoing needs of CMS Medicare Risk Adjustment processes and systems. The ** Medicare ... not live near a Cigna Office]** We have an immediate need to strengthen our Risk Adjustment and Stars Enablement team. The Risk Adjustment and Stars… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and ... leadership/management experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of… more
- The Cigna Group (Denver, CO)
- **Summary** The Medicare Risk Adjustment Advanced Analytics team is searching for a highly motivated and collaborative person to build new data processes, ... and enable analytics. You will work closely with colleagues across the Risk Adjustment business, data science, and data analytics teams to develop new assets,… more
- The Cigna Group (Bluffton, SC)
- …audit. **Qualifications:** Bachelor's degree or equivalent. **5+ years of experience with Medicare Risk Adjustment -is required.** 5+ years of experience ... Risk Adjustment Data Validation Audits required. Strong knowledge of Medicare Risk Adjustment regulations required. Strong knowledge of Risk … more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor, 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 audits… more
- Health First (Rockledge, FL)
- … Risk Adjustment Associates in order to increase awareness of the significance of Medicare Risk Adjustment (MRA) within the CMS Risk Adjustment ... *POSITION SUMMARY * Contribute to Health First Health Plans Risk Adjustment activities that support compliance with...departmental goals and deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human… more
- Centene Corporation (Tallahassee, FL)
- …as a medical coder **2+ years of experience** in coding with knowledge of Medicare risk adjustment (HCC Coding) Required experience in teaching, training ... record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care.… more
- The Cigna Group (Philadelphia, PA)
- …analytics + Strong familiarity with medical claims data + Experience with HHS ACA (or Medicare ) risk adjustment model + Strong database manipulation and SQL ... join the IFP Analytics team responsible for identifying and sizing new risk adjustment opportunities that not only create better health outcomes for patients but… 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
- CareOregon (Portland, OR)
- …years' healthcare, claims, data management, EDI experience Preferred + Experience with Medicare Advantage risk adjustment and payment methodologies ... Advanced knowledge of statistical software packages, such as SAS + Knowledge of risk adjustment methodology and Medicare encounter data + Knowledge of … more
- Providence (Beaverton, OR)
- …the best people, we must empower them._** **Providence Health Plan is calling an HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA who will:** + ... coding audits of hierarchical condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors + Perform audits to ensure compliance… more
- Evolent Health (Columbus, OH)
- …coding guidelines applies daily with experience in MSSP ACO programs, Value Based Care, Medicare Advantage and/or commercial risk adjustment . + You must work ... for the mission. Stay for the culture. **What You'll Be Doing:** The ** Risk Adjustment HCC Coding Support Specialist** at Evolent will be an intricate part of… more
- 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
- Highmark Health (Pittsburgh, PA)
- …Managed Care + 3 years in Budget Administration + Experience in leading Medicare Advantage risk adjustment strategies **LICENSES OR CERTIFICATIONS** ... VP of Revenue Program Management in support of governmental products where Risk Adjustment methodologies apply. Functions as the business owner of the risk… more
- Fallon Health (Worcester, MA)
- …and report on FCHP patient charts for the purpose of validating regulatory Risk Adjustment scores. The Chart Review Specialist will collect diagnostic details ... documentation feedback and submit to Manager for provider education efforts + Update risk adjustment software with all relevant chart review observations + Meet… more
- Molina Healthcare (Richmond, KY)
- …well as automated analytical as well as Reporting modules related to Risk Adjustment for Medicaid, Marketplace and Medicare /MMP. + Assist Risk ... **Job Description** **Job Summary** The Sr Analyst, Risk Adjustment - Predicitve Analytics role...least one line of business among Medicaid, Marketplace and Medicare /MMP. + 3-5 Years of experience in Prospective/Retrospective/Audit targeting… more
- Humana (Frankfort, KY)
- …to customers + Proven experience collaborating across enterprises **Desired Qualifications** + Medicare risk adjustment or stars or experience **Additional ... role, you will support the value story for Humana's risk adjustment and Stars activities overall, as...Quality Reporting and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical… more
- Martin's Point Health Care (Portland, ME)
- …Ideal candidates are those who are coming from a Health Plan and with strong Risk Adjustment and Medicare backgrounds. Job Description 100Key Outcomes: + ... Work" since 2015. Position Summary The Vice President of Risk Adjustment works closely and collaboratively with...Develops and maintains an expert level of knowledge of Medicare and risk -based reimbursement methodologies. + Operational… more
- The Cigna Group (Birmingham, AL)
- …role will work with a series of stakeholders on setting our risk adjustment strategy. Reporting to the Medicare Advantage Revenue Finance lead, this position ... Medicare finance and operation teams to ensure appropriate risk adjustment goals are developed, set, and...deliverables. + Develops and maintains an advanced knowledge of Medicare Advantage risk adjustment and… more
- The Cigna Group (Chattanooga, TN)
- …in Chattanooga area** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in ... 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
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