- CVS Health (Tallahassee, FL)
- …standards are upheld. Preferred Qualifications + A minimum of 5 years expertise in Risk Adjustment payment models for Medicare Advantage, ACA and Medicaid. + ... with the ACA Commercial Stakeholders, ensure timely reconciliation of claims for encounter submission deadlines; while also meeting the...Expertise in Risk Adjustment timelines and requirements + Prefer… more
- Intermountain Health (Tallahassee, FL)
- …revenue, maintaining compliance with CMS and modeling financial impacts of changes in risk adjustment data and methodologies. This position interacts with ... **Job Description:** The Risk Adjustment Analyst performs data...chart review and prospective initiatives. The Risk Adjustment Analyst gathers, standardizes, and consolidates financial claims… 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
- Humana (Tallahassee, FL)
- …**Preferred Qualifications** + Experience working with Medical Claims or other healthcare data + Medicare Risk Adjustment Experience + Masters Degree ... other strategic initiatives to inform the overall revenue forecast. Claims data as well as data...data to project and track specific sources of risk adjustable revenue + Evaluate strategic initiatives and programs… 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
- 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