- Emanate Health (Covina, CA)
- …MSO personnel on HCC and STAR measures related tasks. Responsible to ensure the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon ... Experience Requirement :** Must have at least one year of experience in Medicare HCC program within IPA, HMO, or clinic setting. Two to five years of coding… more
- Point32Health (Canton, MA)
- … adjustment engagement with senior leaders at contracted provider organizations. + ** Risk Adjustment Program Management and Vendor Evaluation** : The ... provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare ,...Manager will be responsible for risk adjustment program management and… more
- Elevance Health (West Des Moines, IA)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and… more
- CareFirst (Baltimore, MD)
- …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...Adjustment . + Successful completion of a Coding Certificate program from an accredited organization (ie, CPC, CRC, CPMA… more
- CareFirst (Baltimore, MD)
- …**Knowledge, Skills and Abilities (KSAs)** + Deep knowledge of regulatory compliance and risk adjustment program integrity. + Experience developing & ... **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes...and problem resolution to meet business operational requirements for Medicare Advantage(MA), Affordable Care Act (ACA) & Medicaid Lines… more
- Centene Corporation (Jefferson City, MO)
- …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... risk adjustment and/or compliance required + Risk Adjustment /HCC coding required + Medicare...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- MVP Health Care (Schenectady, NY)
- …of Hierarchical Condition Categories (HCC)s and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare ... innovative thinking and continuous improvement. To achieve this, we're looking for a ** Risk Adjustment Analyst** to join #TeamMVP. This is the opportunity for… more
- Amazon (FL)
- …Jan 8, 2026 As a Program Manager II on the One Medical At - Risk team, you will be the primary builder of new and existing capabilities and programs aimed ... at improving health outcomes for our at- risk patient populations. Working within Amazon's mission to be...balancing time, quality, and resources to optimize project and program outcomes * Lead the end-to-end implementation of new… more
- Humana (Salt Lake City, UT)
- …gained from actual experience of chronic condition documentation and coding audits, risk adjustment program implementation and provider education delivery. ... + Assist providers in understanding the CMS - HCC Risk Adjustment program as a...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… 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)** ... candidate will manage, clean, and analyze administrative datasets (eg, Medicare claims, prescribing, and corporate ownership data); write reproducible...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
- Blue KC (Kansas City, MO)
- …groups. + Analyze data and monitor provider metrics to identify risk adjustment , HEDIS or educational opportunities for the Medicare Advantage and Qualified ... programs focused on improving the quality of care for Medicare Advantage & Qualified Health Plan (ACA) Members. +...+ Provide training on Stars measures, risk adjustment coding practices, and Blue KC program … more
- Amazon (IL)
- …email requests in a timely manner. Work collaboratively with the Medicare Risk Operations team to ensure positive program outcomes. Basic Qualifications * 2+ ... current on CPT, ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance. Assign appropriate ICD-10-CM, CPT, and other relevant… more
- Molina Healthcare (Iowa City, IA)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives ... Practice Transformation plan is in place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** + Ensures assigned Tier 2 &… more
- Amazon (New York, NY)
- …economics reporting and ad-hoc analysis relating to cost of care management - Medicare Risk score projections and premium estimation -Design and implement ... -Value based care contracting support and ongoing financial and risk analysis. -Support ongoing actuarial support for outside auditor...in value-based care, including CMS initiatives such as the Medicare Shared Savings Program (MSSP) and ACO… more
- Corewell Health (Grand Rapids, MI)
- We are seeking a highly analytical and detail-oriented Risk Adjustment Reporting Developer to support our organization's Medicare Advantage, ACO, ACA, and ... BIDs, Data Engineers, Data Scientists, and internal/external customers. Essential Functions + Risk Adjustment Analytics & Reporting + Develop and deliver… more
- Hartford HealthCare (Farmington, CT)
- …support documentation practices that comply with CMS on evaluation and management, procedure, risk adjustment program requirements and ICD 10 coding ... documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the… more
- Hartford HealthCare (Farmington, CT)
- …observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition ... Documentation Integrity (CDI) by providing day-to-day oversight of the program . They also represent and support CDI at the...capture (HCC) codes, risk adjustment , and other high quality documentation outcome measures. .… more
- ChenMed (Miami, FL)
- …and regulations, coding, and reimbursement processes + Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes ... cycle process. The incumbent also serves as a subject matter expert on risk - adjustment and medical economics to aid in the development of revenue related… more
- New York State Civil Service (Brooklyn, NY)
- …treatment teams to mitigate potential for infectious disease.* Developing infection control risk assessment and plan along with educational programs for staff and ... patients.* Evaluating the effectiveness of the infection control program and revising as needed.* Leading annual flu prevention, treatment, and reporting.*… more
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