- The Cigna Group (Houston, TX)
- …**Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned populations in an ... of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It...health plan coding initiatives guidelines and requirements of the Risk Adjustment program to ensure… more
- CVS Health (Overland Park, KS)
- …MSSP, ACO REACH).** **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk contracts and ACOs ... Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis -Excellent oral &...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… 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 ... Adjustment Data Validation Audits required. Strong knowledge of Medicare Risk Adjustment regulations required....for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… more
- 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 ... Office]** We have an immediate need to strengthen our Risk Adjustment and Stars Enablement team. The...for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… 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 ... the Quality Program to implement tactics for risk adjustment optimization, particularly for provider and...experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions.… 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… 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...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- Elevance Health (Atlanta, GA)
- … areas including but not limited to: claims, grievances and appeals, Part D and risk adjustment . + Knowledge of Risk Adjustment Payment methodologies ... design, develop and lead activities to ensure an effective Compliance program . + Oversees programs for multiple departments/functions with numerous stakeholders and… more
- Health First (Rockledge, FL)
- …* Works with Government Program Director to develop a comprehensive, long-term Medicare risk adjustment strategy. *Stewardship: * * Responsible for ... * * Manages, coordinates and evaluates the activities of personnel engaged in Medicare Risk Adjustment audits, clinical coding and related projects… more
- Point32Health (MA)
- …in a timely manner. Researches and resolves coding questions and risk adjustment regulatory issues. + Coding Program Evaluation. Provides coding expertise to ... evaluate internal and vendor coding program opportunities. Summarizes and presents recommendations to key internal...of healthcare operations. + Ability to read and understand Medicare Advantage and ACA Risk Adjustment… more
- CVS Health (New Albany, OH)
- …+ Strong written and verbal communication. **Preferred Qualifications** + Risk adjustment program experience within Medicare . **Education** + Bachelor's ... opportunity for a Program Manager to join our Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP lines of business! In this… more
- Health First (Rockledge, FL)
- *POSITION SUMMARY* This role contributes to Health First Health Plans' (HFHP) Risk Adjustment data collection, supporting compliance with regulatory and ... business. This individual will ensure the integrity of HFHP risk adjustment data by critically analyzing and...Microsoft Access preferred. o Knowledge and understanding of Federal Medicare program , Medicare Advantage Plans,… 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 + ... completion of at least one AHIMA or AAPC certified program with the achievement of the correlating professional credential...Profit Sharing * STD, LTD, Life Insurance, and FSA Program * Paid AAPC and AHIMA corporate memberships *… more
- 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 (Sunrise, FL)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage requiredAbility ... on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. + Schedules, prepares for and… more
- The Cigna Group (Seattle, WA)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + ... on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. + Schedules, prepares for and… more
- The Cigna Group (Franklin, TN)
- …and Customer strategy, performing research and analysis within the Clinical, STARS, and Risk Adjustment Analytics team. Reporting to the Senior Manager of ... recommendations based on relevant findings. The Clinical, STARS, and Risk Adjustment Analytics team seeks to provide...clinical programs, customer value, growth, and retention for Cigna Medicare . This role will help us accomplish this through… more
- Molina Healthcare (Phoenix, AZ)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality… more
- The Cigna Group (Atlanta, GA)
- …(which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, Provider Relations, and ... and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance...for utilization and cost management. + Acting as government program knowledge leader for the local market. + Responsible… more
- The Cigna Group (Houston, TX)
- …for Accountable Care. This role will be responsible for executing analytics around ACO/ Risk Bearing Entity programs to help measure and evaluate the cost and quality ... and identify trends, variances, and key issues and provide recommendations for adjustment + Prepare and improve financial analysis and forecasting methodologies +… more
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