• Medicare Risk Adjustment

    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
    The Cigna Group (08/16/24)
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  • Senior Director, Medicare Risk

    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
    Somatus (10/09/24)
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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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  • Legal Compliance Advisor- Medicare Part C…

    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
    The Cigna Group (09/24/24)
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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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  • Medicare Advantage Risk

    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
    UCLA Health (08/29/24)
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  • HFHP Risk Adjustment Operations…

    Health First (Rockledge, FL)
    …* * Manages, coordinates and evaluates the activities of personnel engaged in Medicare Risk Adjustment audits, clinical coding and related projects ... vendors. * Works with Government Program Director to develop a comprehensive, long-term Medicare risk adjustment strategy. *Stewardship: * * Responsible for… more
    Health First (11/07/24)
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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 Auditor Educator

    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
    Centene Corporation (09/25/24)
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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 (11/07/24)
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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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  • Medicare Operations Program Management…

    The Cigna Group (Bloomfield, CT)
    …the Medicare market and operations environments + 5+ years' experience in Medicare risk adjustment rating related role, identifying opportunities, and ... Reporting to the Risk Adjustment Strategy and Operations Leader,...implementing initiatives to drive improved rating performance + Medicare Compliance experience preferred + Project Planning experience preferred.… more
    The Cigna Group (11/07/24)
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  • HCC Risk Adjustment QA Auditor:…

    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 Hhierarchical Condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors + Perform audits to ensure compliance… more
    Providence (10/31/24)
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  • Risk Adjustment Coder II

    Point32Health (MA)
    …medical and business side of healthcare operations. + Ability to read and understand Medicare Advantage and ACA Risk Adjustment protocols. + Professional, ... here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Risk Adjustment Supervisor/Manager, performs accurate and timely review and… more
    Point32Health (10/09/24)
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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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  • Financial Analyst

    Humana (Louisville, KY)
    …to an eagerness to learn. + Works with other associates in Stars Analytics and Medicare Risk Adjustment + Distills complex financial and non-financial data ... performance issues **Preferred Qualifications** + Financial or actuarial background + Medicare Risk Adjustment Experience + Medicare Advantage or… more
    Humana (11/05/24)
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  • VP Hqri Operations

    Humana (Louisville, KY)
    Adjustment , including but not limited to + Medical Record Retrieval for all Medicare and Commercial Risk Adjustment functions (retrospective review and ... all compliance and audit processes) and HEDIS + Coding Operations for Medicare and Commercial Risk Adjustment + Management of multiple vendors who provide… more
    Humana (10/29/24)
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  • Actuary, Member Mix and Underwriting Margin…

    Humana (Columbus, OH)
    …the impact on underwriting margin. They will work collaboratively with peers across Medicare Risk Adjustment , Membership Growth Analytics, Medicare ... Experience with member cohort/segmentation, Medicare Membership Report (MMR), Medicare Risk Adjustment (MRA), or membership growth analytics **Scheduled… more
    Humana (10/29/24)
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  • Market VP, Provider Engagement- NE Region

    Humana (Harrisburg, PA)
    …respective functions with a focus on Provider Engagement, outcomes/results, Quality/Stars, and Medicare Risk Adjustment . Represents the health plan ... Strong knowledge and experience of Provider engagement, value-based arrangements, Quality/Stars, and Medicare Risk Adjustment . + Ability to closely partner,… more
    Humana (10/29/24)
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  • Senior STARS Improvement Consultant

    Humana (Montgomery, AL)
    …with physician groups and influencing execution of recommended strategy + Experience with Medicare Risk Adjustment and/or medical coding + Understanding of ... Senior Stars Improvement Consultant / Professional executes the overall Medicare Stars Improvement Program within the market, including development, implementation… more
    Humana (10/31/24)
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