- 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
- Martin's Point Health Care (NY)
- …certified as a "Great Place to Work" since 2015. Position Summary The Risk Adjustment Reporting and Data Analystanalyzes data, reviews findings, and develops ... as key sources of data. The Senior Analyst uses their extensive risk adjustment content knowledge and analytical expertise to guide and educate leaders on… more
- VNS Health (Manhattan, NY)
- …CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding ... evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC… 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** **Alternate locations may be considered:** This position will work in a hybrid model (remote and ... of our Elevance Health PulsePoint locations. The **Business Change Director for Risk Adjustment Data Quality** will serve as a strategic partner for the… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment ... monitoring of key performance indicators to enable operational excellence within the risk adjustment department. You will be responsible for coordinating mock… 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
- LifePoint Health (Denver, CO)
- …care, we may have your next opportunity. We are currently seeking an Outpatient Risk Adjustment Coder. This remote-based position willbridge the gap between the ... submission to validate an accurate representation of the severity of illness, risk adjustment and facilitate proper coding. This role will focus on the… 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
- 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
- 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)
- …travel to areas surrounding Tempe and Tucson, 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
- ChenMed (Miami, FL)
- …We're rapidly expanding and we need great people to join our team. The Risk Adjustment Auditor works in a collaborative effort directly with physicians, their ... is to ensure that medical documentation and supportive evidence complies with risk adjustment initiatives, improving revenue cycle and denial of payments.… more
- Medical Mutual of Ohio (OH)
- …Medicare Supplement, and individual plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance, ... review of provider agreements.** + **Acts as project manager over large internal risk adjustment projects (eg, Optum In Office Assessment program for both MA and… more
- Trinity Health (Columbus, OH)
- …leading education training and development opportunities to keep you working at yours. Risk Adjustment Coding Specialist works in a team environment and is ... Forms and maintains accurate database of submission and payment. + Certified Risk Adjustment Coder certification within one year of hire required. + Minimum of… more
- Centene Corporation (Columbia, SC)
- …Reporting and has a complete understanding of these guidelines. + Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines. ... + Understands the impact of ICD-10 codes on the CMS HCC risk adjustment model. + Ability to meet productivity and accuracy standards + Ability to defend coding… more
- Corewell Health (Grand Rapids, MI)
- …Location SITE - Priority Health - 1231 E Beltline - Grand Rapids Department Name Risk Adjustment Employment Type Full time Shift Day (United States of America) ... Weekly Scheduled Hours 40 Hours of Work 8 am to 5 pm Days Worked Monday to Friday Weekend Frequency N/A CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health… more
- MedKoder (Mandeville, LA)
- …hands-on production). Must have at least 1 year of specialized experience in Medicare Risk Adjustment disciplines- such as HCC, CCC HEDIS + Auditing experience a ... PLUS. ICD-10 experience/education a PLUS. About MedKoder, LLC: * Privately held, growing company with strong values and ethics * Professional development and education * All positions are permanent - no contracts or sitting on a "coding bench" * Generous paid… more
- Baylor Scott & White Health (Columbus, OH)
- …and their role in the final Diagnosis Related Group, Severity of Illness, and Risk of Mortality. **SALARY - WORK MODEL** 100% Remote The pay range for this ... to support the appropriate severity of illness (SOI), expected risk of mortality (ROM) and complexity of care of...the final Diagnosis Related Group, Severity of Illness, and Risk of Mortality Able to determine complete, accurate and… more
- Molina Healthcare (NE)
- …**Job Summary** Responsible for estimating liabilities, establishing premium rates, financial analysis and reporting. Extracts, analyzes, and synthesizes data from ... various sources to identify risks. **KNOWLEDGE/SKILLS/ABILITIES** + Support the development of the IBNR estimates and rate adequacy studies. Document assumptions. + Analyze results to identify early signs of trends or other issues related to medical care… more
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