- 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
- 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 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...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- Point32Health (Canton, MA)
- …lines. The Data Analyst will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and ... including but not limited to the collection, organization, and distribution of all incoming risk adjustment program data + Create, compile and format… more
- Centene Corporation (Raleigh, NC)
- …department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which ... includes implementation of elements of an effective compliance program . Oversees the development of risk assessments...assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to… 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 (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
- Molina Healthcare (Long Beach, CA)
- …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
- LA Care Health Plan (Los Angeles, CA)
- …skills Preferred: Knowledge of managed care and health care claims Knowledge of Risk Adjustment models (eg CMS Medicare Advantage, HHS-HCC, Medicaid ... Manager, Analytics Job Category: Accounting/Finance Department: Risk Adjustment Strategies & Initiatives Location: Los Angeles, CA, US, 90017 Position Type: Full… more
- Medical Mutual of Ohio (Toledo, OH)
- **Job Summary:** Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA ( Medicare Advantage) with ... precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA....including jeans. Excellent Benefits and Compensation: + Employee bonus program . + 401(k) with company match up to 4%… more
- CVS Health (Houston, TX)
- …Health has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role you will provide complex analytics ... and reporting to support Medicaid Risk Adjustment to address business questions regarding...with internal departments, including but not limited to: Finance, Medicare Operations, Network Management, Provider Contracting, and Health Economics,… more
- Fairview Health Services (St. Paul, MN)
- …documentation for clinical conditions and procedures to reflect severity of illness, risk adjustment , accurate coding, accuracy of patient outcomes, and ... informally, regarding the impact of documentation on patient care, quality metrics, risk adjustment , and correct reimbursement. Adheres to departmental and… more
- LA Care Health Plan (Los Angeles, CA)
- …Performance Management QI/QPM and Health Information Management (HIM) analytics support, Risk Adjustment , other plan operations business units, and network ... Clinical Quality Program Manager III Job Category: Clinical Department: Quality...not limited to QI, Pharmacy, Care Management, Utilization Management, Risk Adjustment , Products, Customer Solution Center (CSC),… more
- Elevance Health (Seven Fields, PA)
- …(Operational)** The Sr. Business Consultant will support the Advanced Primary Care risk adjustment team through vendor engagement, reporting and identifying ... have a healthcare background with a strong understanding of Risk Adjustment . You should have experience in...adjustment and/or health insurance industry. + Experience in Medicare Advantage and Medicaid in a provider based or… more
- Molina Healthcare (Los Angeles, CA)
- …Specialist, Provider Quality contributes to one or more of these quality improvement/ risk adjustment functions: + Implements key quality and population health ... strategies and risk adjustment , alongside providers and with direction...with and between key provider network partners. + Evaluates project/ program activities and results to identify opportunities for improvement.… more
- Elevance Health (Richmond, VA)
- **Title: Manager Government Business other revenue programs (Manager Risk Adjustment Quality Control)** **Location: Chicago IL, Indianapolis IN, Grand Prairie ... Overview:** Responsible for ensuring the overall success of our Medicare and Medicaid 'Other' Revenue programs with the intent...management experience in a managed care setting with extensive risk adjustment experience with a focus on… more
- Atlantic Health System (Morristown, NJ)
- …of mandatory Organized Delivery System filings + Responsibility for supplemental submission of Medicare Risk Adjustment Files associated with Medicare ... payer lines of business + Engage in assessments of MSSP - Medicare Shared Savings Program participation as required by the ACOs. + Communicate and educate on… more
- Sharp HealthCare (San Diego, CA)
- …with clinicians and their staff to achieve improvements in risk adjustment documentation, data validations, as well as program participation. + Coding ... experience working as a certified coder. + 2 Years experience working as a HCC risk adjustment coding auditor. + Experience with medical billing and with medical… more
- St. Luke's University Health Network (Easton, 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
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