- The Cigna Group (Houston, TX)
- ** Risk Adjustment Provider Educator - Houston** **Must reside in Houston, TX - Field based** **Requires travel to provider offices in and around coverage area.** ... Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned populations in an operational market.… more
- VNS Health (Manhattan, NY)
- OverviewSupports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk ... resources to increase knowledge and improve return on investment (ROI) of risk adjustment activities. Understands risk adjustment models in emerging… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of key risk ... and actionable reports to solve problems, provide data-driven guidance, and monitor risk adjustment performance. Provide analytical support on various strategies… more
- Highmark Health (Columbus, OH)
- …requires the incumbent to: + **Lead and manage a team of interoperability and risk adjustment SMEs:** Provide guidance, mentorship, and support to team members, ... ensuring accurate and timely data flow across systems. + **Oversee risk adjustment processes and ensure compliance with regulations:** Stay abreast of evolving… more
- Point32Health (Canton, MA)
- …and Operations, this individual will support the operations and analysis of risk adjustment strategy across Point32Health business lines. The Data Analyst ... will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and synthesizing results to develop… more
- Elevance Health (Atlanta, GA)
- **Business Change Director- Risk Adjustment Data Quality** **Location:** This position will work a hybrid model (remote and office). Ideal candidates must live ... within 50 miles of a PulsePoint location. The **Business Change Director for Risk Adjustment Data Quality** will serve as a strategic partner for the Enterprise … more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Specialist supports prospective risk adjustment via concurrent review and supplemental ... data CMS filing, HHS- Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review… 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 with IPAs on risk adjustment strategies to achieve health plan goals and KPIs + Presenting and… more
- Highmark Health (Pittsburgh, PA)
- …This job provides end-to-end management, delivery and support to new and existing Risk Adjustment Programs. The incumbent will deliver value to the Health ... business outcomes and achieve strategic objectives relative to new and existing Risk Adjustment Programs. Supports other key objectives designed to… more
- Martin's Point Health Care (Portland, ME)
- …Summary **NEW REMOTE POSITION** **Health Plan Operations** **APPLY TODAY!** The Senior Risk Adjustment Analyst analyzes data, reviews findings, and develops ... hoc reporting used in complex conceptual analyses for all departments within Risk Adjustment Operations + Develops systematic reporting processes and procedures… 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 plan. You will: + Conduct medical record audits… more
- CenterWell (Tallahassee, FL)
- …our caring community and help us put health first** The Associate Director, Risk Adjustment oversees quality assurance audits of medical records, ICD-10-CM, CPT, ... other payers, and over government agencies. In addition, the Associate Director, Risk Adjustment oversees all medical coding education activities. The Associate… more
- Centene Corporation (Raleigh, NC)
- …and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to ensure implement effective prevention,… more
- Centene Corporation (Phoenix, AZ)
- …remote from home. Candidate must live in Arizona. **Position Purpose:** Utilize risk adjustment methodologies, principles, and knowledge of managed care ... providers. + Develop collaborative relationships with providers to educate and improve Risk Adjustment coding and documentation competencies. + Use knowledge of… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …with Premera Medical Directors and Provider Network Executives, the **Quality and Risk Adjustment - Provider Clinical Consultant (PCC)** works directly with ... training is available for documentation and coding best practices for HEDIS and risk adjustment . This role will have a positive impact on our clinical quality… more
- TEKsystems (Minneapolis, MN)
- …the team's current focus is on meeting the January deadline. Role: Enterprise Risk Adjustment Submissions Analyst, Sr The Government Programs Enterprise Risk ... CMS (The Centers for Medicare & Medicaid Services) rules and regulations for Risk Adjustment submissions, along with strong knowledge and understanding of… more
- Elevance Health (Columbus, OH)
- **Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... 50 miles of our Elevance Health PulsePoint locations. The **Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for planning, directing… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** **Description:** **CERTIFIED RISK ADJUSTMENT CODING SPECIALIST** **Location:** Trinity Health PACE Corp Michigan ... thru AHIMA + Must be certified or obtaining certification for Certified Risk Adjustment Coder thru AAPC. If not obtaining, must obtain within one year… more
- System One (Houston, TX)
- …responsible for risk score tracking and improvement. + Maintains internal risk adjustment models using published documentation. + Manages projects, including ... + 4-6 years management experience strongly preferred. + Experience with various risk adjustment models including the CMS Medicare model, CMS ACA Model and 3rd… more
- Elevance Health (St. Louis, MO)
- …actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + Analyzes and implements risk ... background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience is strongly preferred. Please be… more
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