- Medical Mutual of Ohio (OH)
- …and perform pre-employment substance abuse and nicotine testing._ **Title:** _Risk Adjustment Provider Programs Specialist_ **Location:** _Ohio_ ... plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance,...as project manager over large internal risk adjustment projects (eg, Optum In Office Assessment program… more
- Molina Healthcare (OH)
- …& ABILITIES:** * 4+ years of program and/or project management experience in risk adjustment and/or quality * 4+ years of experience supporting HEDIS engine ... limited to: Risk /Quality rate trending and forecasting; provider Risk /Quality measure performance, CAHPS and survey...activity, risk adjustment targeting and reporting systems *… more
- Molina Healthcare (Akron, OH)
- …& ABILITIES:** * 8+ years of program and/or project management experience in risk adjustment and/or quality * 4-6 years of experience supporting HEDIS engine ... limited to: Risk /Quality rate trending and forecasting, provider Risk /Quality performance, CAHPS and other survey...activity, risk adjustment targeting and reporting systems *… more
- Molina Healthcare (OH)
- …& ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of experience supporting HEDIS engine ... limited to: Risk /Quality rate trending and forecasting; provider Risk /Quality measure performance, CAHPS and survey...activity, risk adjustment targeting and reporting systems *… more
- Medical Mutual of Ohio (OH)
- …**Medical Coding Compliance Specialist I** Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA ... the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million...precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA.… more
- Evolent (Columbus, OH)
- …ECP's Clinical, Performance and Network teams. Additionally, the MD will oversee ECP's Risk Adjustment program , with responsibility for developing our ... plans related to medical expense management, quality improvement, appropriate risk adjustment , and patient and provider...payor contracts and CMS policies impacting risk adjustment , and manage the suite of internal programs… more
- Medical Mutual of Ohio (Toledo, OH)
- **Job Summary:** Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA (Medicare Advantage) with ... precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA....specifications + Basic knowledge and understanding of hospital and provider operations as it applies to medical coding and… more
- Highmark Health (Columbus, OH)
- …other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and ... to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare...for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works… more
- Medical Mutual of Ohio (OH)
- …project lead for large provider groups. Supports other initiatives related to Risk Adjustment Programs (RAPS) and Healthcare Effectiveness Data and ... Record Retrieval Specialist** Supports the company's risk adjustment projects by collaborating with vendors and provider...to retrieve medical records. Supports other initiatives related to Risk Adjustment Programs (RAPS) and… more
- reveleer (OH)
- …Care Organizations nationwide, leveraging software and other technology tools to accelerate their Risk Adjustment and Quality programs . Our mission is to ... fast-growing technology-enabled services company that powers performance/quality measurement and risk adjustment solutions in healthcare. Specifically, Reveleer… more
- Elevance Health (Mason, OH)
- **Title: Manager Government Business other revenue programs (Manager Risk Adjustment Quality Control)** **Location: Chicago IL, Indianapolis IN, Grand ... validation of programs ROI while ensuring the programs are in compliance of CMS program ...management experience in a managed care setting with extensive risk adjustment experience with a focus on… more
- Medical Mutual of Ohio (OH)
- … offices/facilities to retrieve medical records. Supports other initiatives related to Risk Adjustment Programs (RAPS) and Healthcare Effectiveness Data ... the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million...and individual plans. Supports the company's risk adjustment projects by collaborating with vendors and provider… more
- Humana (Columbus, OH)
- …the provider reconciliation program . Will require an in depth understanding of risk adjustment and be able to clearly articulate the value of the ... Professional promotes and improves the quality and measurement of provider education programs with a market(s). The...+ Bachelor's degree or 2+ years equivalent experience in Risk Adjustment + Experience working with Claims… more
- Trinity Health (Columbus, OH)
- …Ohio Insurance License (Life and Health) or obtained within 90 days of hire. Risk Adjustment department: None + Experience: One to three years experience ... variety of professional roles including information technology, financial analysis, audit, provider relations and more. We know that exceptional patient care starts… more
- Highmark Health (Columbus, OH)
- … performance under value based reimbursement contracts, STARs performance, HEDIS performance, Risk Adjustment documentation and any other risk based ... the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. + Develop and… more
- Molina Healthcare (OH)
- …managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... on developing financial models to evaluate the impact of provider reimbursement changes + Provide data driven...in healthcare + Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans + Analytical work experience… more
- Molina Healthcare (Columbus, OH)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with… more
- Molina Healthcare (OH)
- …+ Coordinates accountabilities between segment and markets to drive performance in network, risk adjustment , and stars; single point of contact for escalations ... responsible for the development and administration of Segment specific departments, programs and services, in alignment with Molina Healthcare's overall mission,… more
- Humana (Columbus, OH)
- …of Health Insurance Payer experience + 1+ year or greater experience in Risk Adjustment , Stars and Quality and/or Claim Administration/Payment Integrity support ... us put health first** At Humana, we are leading the industry in payer-to- provider interoperability and driving better outcomes for our providers and members. In this… more
- Deloitte (Cincinnati, OH)
- …waivers (ie, 1115, 1915 b/c, 1332) + 1+ years experience with risk adjustment mechanisms + 1+ years experience with Provider reimbursement streams (ie, DSH, ... be eligible to participate in a discretionary annual incentive program , subject to the rules governing the program... program , subject to the rules governing the program , whereby an award, if any, depends on various… more