- 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
- Medical Mutual of Ohio (OH)
- …of provider agreements.** + **Acts as project manager over large internal risk adjustment projects (eg, Optum In Office Assessment program for both MA and ... Supplement, and individual plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance, and… 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
- 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
- AdventHealth (Altamonte Springs, FL)
- …summarizing and trending all aspects of Medicare business, CMS Revenue, Enrollment, Risk Adjustment , cost trend, and quality + Serve as the liaison between ... data warehouse to derive insights on medical cost opportunities, risk adjustment accuracy opportunities, quality opportunities, and...Advantage and ACO REACH data + Perform analysis of risk -based Medicare populations and program … more
- Humana (Miramar, FL)
- …the health of our members; and the attainment of Stars scores and management of Risk Adjustment . + Responsible for the overall P&L management for the region, ... community and help us put health first** The VP Medicare Regional President will be responsible for the development...arrangements between health plans and providers + Knowledge of risk arrangements and ability to influence these arrangements. +… more
- Molina Healthcare (San Bernardino, 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
- Henry Ford Health System (Troy, MI)
- …audits including but not limited to coordination, documentation and coding of CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) and ... Knowledge of computer software programs used for data collection. + Knowledge of Medicare Advantage risk adjustment payment methodology preferred. +… more
- Healthfirst (NY)
- …and Responsibilities** + Assume leadership role in the delivery and execution of the risk adjustment program by driving value through data driven decisions ... and Medicaid Services (CMS) practices, policies, and regulations. Expert knowledge of Medicare Risk Adjustment Payment Methodology, HCC, CRG and other… more
- VNS Health (Manhattan, NY)
- …records, including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required + 2 years of experience in ... of opportunity to support accuracy clinical documentation. Works with Risk Adjustment and Quality team to identify...education programs. + Designs and develops teaching plans and program content for provider education and ensure it meets… more
- Medical Mutual of Ohio (OH)
- …**Medical Coding Compliance Specialist I** Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans....precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA.… more
- Henry Ford Health System (Troy, MI)
- …and vendor-driven projects. Become proficient using the Altegra RiskView systems for both Medicare Advantage Risk Adjustment and Healthcare Reform Risk ... audits including but not limited to coordination, documentation, and coding of CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) and… more
- Medical Mutual of Ohio (OH)
- …of life. **Responsibilities** **Medical Record Retrieval Specialist** Supports the company's risk adjustment projects by collaborating with vendors and provider ... offices/facilities to retrieve medical records. Supports other initiatives related to Risk Adjustment Programs (RAPS) and Healthcare Effectiveness Data and… 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
- Fallon Health (Worcester, MA)
- …of care provided and coded * Assist in the collection and analysis of risk adjustment data in-order to identify documentation, coding trends and opportunities * ... regulatory updates * Develop and coordinate education and training that focuses on Risk Adjustment coding and documentation opportunities utilizing a variety of… more
- AdventHealth (Shawnee, KS)
- **Inpatient Social Worker OR RN-Case Manager Weekend Worker Program Days** **All the benefits and perks you need for you and your family:** + Vision, Medical & ... Dental Benefits from Day One + Student Loan Repayment Program + Received Magnet(R) recognition from the American Nurses...the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for… more
- Marshfield Clinic (Marshfield, WI)
- …stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy ... and integrity of risk adjustment data submitted to the Centers for ...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… 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
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