- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment ... 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
- 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)
- …direction. You 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 is instrumental in participating in the planning with...key performance indicators to enable operational excellence within the risk adjustment department. You will be responsible… more
- Providence (CA)
- … Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical background + ... providing critical insights to enhance the performance of our Medicare Advantage plans **_Please note the following...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- Humana (Sacramento, CA)
- …in-depth evaluation of variable factors **Preferred Qualifications** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in business, ... Quality Reporting and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical...Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… more
- Humana (Sacramento, CA)
- …+ Ability to work under minimal supervision **Preferred** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in business, finance, ... Quality Reporting and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical...Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI… more
- UCLA Health (Los Angeles, CA)
- …will lead and oversee risk -based audits and compliance initiatives for our Medicare Advantage (Part C) and Prescription Drug (Part D) programs ('MAPD'). This ... Description As the Medicare Advantage Compliance Audit Manager, you...Internal Auditor (CIA), Certified Professional Coder (CPC) or Certified Risk Adjustment Coders (CRC), highly desired *… more
- Highmark Health (Sacramento, CA)
- …and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team… more