- Elevance Health (West Des Moines, IA)
- ** Risk Adjustment Actuarial Analyst II - Advanced Analytics** **On-Site Requirement:** **Hybrid 1;** **This role requires associates to be in-office 1 - 2 ... granted as required by law._ The ** Risk Adjustment Actuarial Analyst II - Advanced Analytics**...performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …company seeks a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this critical ... role, you will drive the strategic planning, development, and optimization of our Medicare Advantage Risk Adjustment solution, ensuring that our deliverables… more
- Molina Healthcare (Dane, WI)
- …physical examinations. * Captures and documents annual diagnoses accurately consistent with Medicare risk adjustment . * Conducts comprehensive annual ... JOB DESCRIPTION Job Summary Facilitates advanced practice clinical consultations for enrolled members including...acute/primary care and chronic disease management. * Identifies medical risk and collaborates with members of the care team… more
- Humana (Salt Lake City, UT)
- …improvement opportunities and give guidance around operational and clinical best practices in the risk adjustment methodology. This role reports to the Risk ... team to effectively influence a provider to adopt best practices in the risk adjustment methodology. The successful candidate will possess extensive, in-depth… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …for the execution and day-to-day management of data submissions for ACA Commercial, Medicare , and Medicaid risk adjustment and quality programs. * ... team responsible for maintaining, executing, and evaluating initiative impacts using the risk adjustment and quality analytics models across ACA Commercial, … more
- University of Michigan (Ann Arbor, MI)
- …impact of insurer-practice integration on patient access and quality. **2. Upcoding and risk adjustment in Medicare Accountable Care Organizations (ACOs)** ... US primary care. We use large national datasets and advanced statistical (econometric) methods to generate evidence that informs...expected health risk a process known as risk adjustment . Yet this system can be… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and vendor performance relative to established contracts. * Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply broad actuarial...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Amazon (IL)
- …Demonstrates ability to perform accurate and complete chart reviews for Profee and HCC Risk Adjustment * Possesses advanced knowledge and understanding of ... ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance. Assign appropriate ICD-10-CM, CPT,...requests in a timely manner. Work collaboratively with the Medicare Risk Operations team to ensure positive… more
- Harvard University (Cambridge, MA)
- …research related to aspects of the Medicare program, including payment policy, risk adjustment , and competition. Experience working with Medicare claims ... and SAS or Stata) * Demonstrated expertise in causal inference and high-dimensional risk adjustment /predictive modeling, experience with Medicare claims data… more
- Johns Hopkins University (Baltimore, MD)
- …such as claims processing, premium billing, encounter data, utilization management, risk adjustment , provider contracting, quality metrics, and related ... health insurance and managed care programs, including Medicaid and Medicare Advantage. + Deep understanding of the regulatory environment...+ Process Improvement: Advanced + Project Management: Advanced + Risk Analysis: Advanced … more
- Molina Healthcare (Des Moines, IA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and external to ensure accuracy. Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and ... experience supervising or managing people and/or projects or indirectly leading teams. + Advanced knowledge of financial and risk health arrangements. + Strong… more
- St. Luke's University Health Network (Lehighton, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. . Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. . Monitors risk assessment using available tools and implements discharge interventions… more
- St. Luke's University Health Network (Bethlehem, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- Deloitte (Los Angeles, CA)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- SSM Health (MO)
- …scoring. + Collaborates with others regardingclinical documentation improvement (CDI) and risk adjustment (mortality) findings. + Maintains knowledge of Centers ... the current health status of network patients against ever-changing risk adjusted models. Responsible for achieving improved documentation results...for Medicare and Medicaid Services (CMS) requirements related to clinical… more
- Humana (Alachua, FL)
- …community and help us put health first** The Medical Record Retrieval Specialist ( Risk Adjustment Representative 3) Travels to provider offices within the region ... The records are reviewed by Humana's Coding staff. The Medical Record Retrieval Representative ( Risk Adjustment Representative 3): + Travel up to 60% of the time… more
- Sutter Health (Sacramento, CA)
- …finance foundation and solid understanding of provider reimbursement principles-such as risk adjustment , capitation, and fee-for-service-who can apply this ... ensuring accurate setup in collaboration with Operations and MCF.** + **Validate CMS Medicare Advantage and ACA risk scores, along with payer codes, for… more
- Virginia Mason Franciscan Health (Silverdale, WA)
- …the Masters Social Worker include: crisis intervention, patient/family intervention, high- risk screening, brief counseling, referrals for financial or other ... discharges and engagement of appropriate agencies or community resources when high- risk patients are identified. **Essential Key Job Responsibilities** 1. Providing… more
- Virginia Mason Franciscan Health (Burien, WA)
- …the Masters Social Worker include: crisis intervention, patient/family intervention, high- risk screening, brief counseling, referrals for financial or other ... discharges and engagement of appropriate agencies or community resources when high- risk patients are identified. ESSENTIAL KEY JOB RESPONSIBILITIES 1. Providing… more
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