- Sunshine State Health Plan (Tallahassee, FL)
- …and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach ... facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). Identifies specific practice… more
- CVS Health (Tallahassee, FL)
- …standards are upheld. Required Qualifications + 3+ years of experience in Risk Adjustment payment models for Medicare Advantage, ACA or Medicaid. ... teams and/or stakeholders Preferred Qualifications + 5+ years of experience in Risk Adjustment payment models for Medicare Advantage, ACA and Medicaid.… more
- MyFlorida (Tallahassee, FL)
- …and interpret data ; to make and defend decisions about insurance claims ; to plan, organize & coordinate work activities; to communicate effectively verbally & ... offers of settlement up to approved authority and denying claims when necessary. Responsible for the adjustment ...the assigned claim files, including the accuracy of the claims information and reserves in the division's data… more
- Centene Corporation (Tallahassee, FL)
- …and NCQA requirements. + Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on ... provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Identifies specific… more
- Intermountain Health (Tallahassee, FL)
- …trading partner exchanges. This position for Business Analyst-Technical-Senior is on the Encounter Data team in the Risk Adjustment department. This position ... will be responsible for understanding and overseeing the processes that extract claims data , transform it into a specified encounter data submission file,… more
- Humana (Tallahassee, FL)
- …within the Healthcare Quality Reporting and Improvement (HQRI) organization. HQRI (comprised of Risk Adjustment and Health Quality & Stars) is responsible for ... outcomes and advancing the care experience of our members and provider partners. The Risk Adjustment team collects and submits members' health information to CMS… more
- Humana (Tallahassee, FL)
- …closely with internal stakeholders including Finance, Actuarial, Clinical, Medicare Risk Adjustment , Provider Contracting, and Provider Engagement internally ... The Market Finance Lead collects, analyzes and reports on various market data to connect financial outcomes with operational effectiveness. The Market Finance Lead… more
- Evolent Health (Tallahassee, FL)
- …analytics to drive decision making and with Hierarchical Condition Category Risk Adjustment - **Preferred** . + Leadership/ mentoring experience supporting ... arrangements with government and commercial payors, including medical expenses, risk scores, benchmark/premiums, attribution, and (Incurred but not reported) IBNR… more
- Humana (Tallahassee, FL)
- …+ Demonstrated knowledge of Medicare Advantage program + Demonstrated knowledge of risk adjustment and the Stars quality program + Experience in ... to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The...and abuse laws, including the Anti-kickback statute and False Claims Act; + Drafting contract provisions to address regulatory… more