- CARLE (Urbana, IL)
- …not limited to healthcare liens, settlement requests, bankruptcies, bad debt, risk management, estate claims , fraud cases and attorney requests, etc.Handles ... advanced account activities such as settlement and refund requests, bankruptcies, risk management and retro adjudication. Responsible for answering, documenting and… more
- Fallon Health (Worcester, MA)
- …of the Risk Adjustment Analyst (RAA) will be to function as the Claims SME for the Risk Adjustment & Analytics Department. The RAAimplements data ... risk outcome improvement. The RAA will own the claims adjustment workflow associated with regulatory retrospective...Working knowledge of the provider-based healthcare industry, claims processing, provider billing or Risk … 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
- The Cigna Group (Bloomfield, CT)
- …if do not live near a Cigna Office]** We have an immediate need to strengthen our Risk Adjustment and Stars Enablement team. The Risk Adjustment and ... is responsible for developing solution changes for the ongoing needs of CMS Medicare Risk Adjustment processes and systems. The **Medicare Risk Adjustment… more
- VNS Health (Manhattan, NY)
- …Education: + Associate's degree in nursing required Work Experience: + Minimum five years of claims coding and risk adjustment experience in a Medicare or ... OverviewAs the Clinical Manager for Risk Adjustment , you will be at...wellness programs + Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care + Generous tuition reimbursement for… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS- Risk ... and documentation guidelines. The development and ongoing maintenance of the Commercial Risk Adjustment Coding guidelines, as well as, guiding junior coding… more
- UCLA Health (Los Angeles, CA)
- …+ A Certified Professional Coder (CPC) certification and a Certified Risk Adjustment Coder (CRC), required + Bachelor's degree ( healthcare or relevant field) ... Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and...NCQA technical specifications, required + Knowledge of Medicare Advantage billing/ claims submission and other related actions, preferred + Knowledge… more
- Banner Health (Phoenix, AZ)
- …and develops clinical strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of our MA, MSSP, Medicaid, ... care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal...as the clinical DYAD to the Executive Director of Risk Adjustment , co-leading a robust team that… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **CERTIFIED RISK ADJUSTMENT CODING SPECIALIST** **Location:** Trinity Health PACE Corp ... to participant health information for data retrieval, analysis, and claims processing. Duties also include abstracting and validating data...+ Must be certified or obtaining certification for Certified Risk Adjustment Coder thru AAPC. If not… more
- Elevance Health (Indianapolis, IN)
- ** Risk Adjustment Data Reporting Analyst** **Location:** This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 ... our Elevance Health Pulse Point locations. **Preferred Location:** Indianapolis, IN. The ** Risk Adjustment Data Reporting Analyst** is responsible for analyzing,… more
- Centene Corporation (Charlotte, NC)
- …Complete Health Compliance team, you will work with Corporate Shared Services on Risk Adjustment related projects for Chart Retrieval, Research of member, ... provider, and claims data. + Collaboration with vendors, Provider Relations team...preferred. Critical thinking skills needed. **Preferred Skills:** Detailed oriented, healthcare is helpful, MS Office skills, basic computer skills,… more
- Walgreens (Deerfield, IL)
- …attorneys. **Job Responsibilities** + Reviews, analyzes and evaluates the investigation, adjustment and reserving for moderately complex Liability claims . ... is included in the US Retail Pharmacy and US Healthcare segments of Walgreens Boots Alliance, Inc. (Nasdaq: WBA),...handling Liability claims . + Knowledge of Liability claims and 3rd party claim management systems; risk… more
- Molina Healthcare (Richmond, KY)
- **Job Description** **Job Summary** The Sr Analyst, Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics ... with research, development,and completion of special projects. **Knowledge/Skills/Abilities** + Assist Risk Adjustment Data Analytics Leaders in Prospective and… more
- Commonwealth Care Alliance (Boston, MA)
- …including the MHK Market Prominence platform. **Knowledge, Skills & Abilities Required:** ** Healthcare Claims ** Strong knowledge of healthcare claims ... and data, including payment integrity, pricing, editing, encounter submission, and risk adjustment **Cloud Computing Technologies** Knowledge of cloud computing… more
- CVS Health (Hartford, CT)
- …processes. **Preferred Qualifications** + Prior experience in healthcare analytics, risk adjustment , HEDIS, claims /EHR and other care management ... highly skilled and motivated Senior Analyst, Informatics to join our expanding IFP risk adjustment analytics team. In this role, you will play a crucial role in… more
- Independent Health (Buffalo, NY)
- …outcomes. + Establish and implement claims review processes to support risk adjustment . Analyze data and provide strategic insights to enhance pricing ... and other cross-functional teams to align risk adjustment decisions with organizational goals. + Analyze healthcare... adjustment decisions with organizational goals. + Analyze healthcare claims data, enrollment data, and other… more
- Commonwealth Care Alliance (Boston, MA)
- … enrollment systems and data preferably including the MHK Market Prominence platform. + ** Claims ** Strong knowledge of healthcare claims systems and data, ... **Member Service** Strong knowledge of call center processes and supporting systems. + ** Risk Adjustment ** Experience supporting Medicare risk adjustment … more
- Guidehouse (Atlanta, GA)
- …Commercial clients. Projects will include actuarial modeling tasks such as developing healthcare projections, analyzing risk adjustment impacts, and ... payments (VBPs), and other pilot program models + Capitation rate development + Risk adjustment calculations of premium + Development of budget projections +… more
- Molina Healthcare (Nicholasville, KY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms… more
- Centene Corporation (Lansing, MI)
- …Familiarity with claims payment, utilization management, provider/vendor contracts, risk adjustment for government sponsored healthcare desired. ... fresh perspective on workplace flexibility. **Position Purpose:** The Senior Manager, Healthcare Analytics drives the execution of analytics strategy through the… more
