- CVS Health (Columbus, OH)
- …Health Medicaid Plans. Reporting to the Lead Director of Medicaid Risk Adjustment , the Market Manager will work closely with cross-functional ... Risk Adjustment Coder (CRC) Prior experience in Risk Adjustment field/ Medicaid **Education** Bachelor's Degree required from an accredited four… more
- Point32Health (Canton, MA)
- …and Operations, this individual will support the operations and analysis of risk adjustment strategy across Point32Health business lines. The Data Analyst ... will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and synthesizing results to develop… more
- Medical Mutual of Ohio (OH)
- …delivery approach and assist in the review of provider agreements.** + **Acts as project manager over large internal risk adjustment projects (eg, Optum In ... Medicare Supplement, and individual plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance,… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: RMRA (Revenue Management Risk Adjustment ) Health Risk Coding and Education Specialist - Level II, specific to the Risk Adjustment ... not limited to coordination, documentation and coding of CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) and vendor service project Risk… more
- Elevance Health (Mason, OH)
- **Title: Manager Government Business other revenue programs ( Manager Risk Adjustment Quality Control)** **Location: Chicago IL, Indianapolis IN, Grand ... for ensuring the overall success of our Medicare and Medicaid 'Other' Revenue programs with the intent of enhancing...management experience in a managed care setting with extensive risk adjustment experience with a focus on… more
- VNS Health (Manhattan, NY)
- …arrangements, vendor contracting, budget planning and Medicare bid. + Maintains and updates the risk adjustment models used for developing risk adjustment ... boundaries and decision making that drives results. As the Manager , Actuary for Medicare Advantage (MA), you will play...risk scores, identifying data reporting gaps and projecting risk scores for Medicare bid. + Supports annual Medicare… more
- reveleer (OH)
- …in a customer-facing account or vendor management role, managing Risk Adjustment projects specific to Medicare, Medicaid , and Commercial lines of business, ... fast-growing technology-enabled services company that powers performance/quality measurement and risk adjustment solutions in healthcare. Specifically, Reveleer… more
- Henry Ford Health System (Troy, MI)
- …community improve with accurate submission of clinical documentation and coding of risk adjustment data through a combination of education and engagement ... using the Altegra RiskView systems for both Medicare Advantage Risk Adjustment and Healthcare Reform Risk...Senior Leadership and Corporate. + In conjunction with the manager and Corporate Compliance Department, for the completion of… more
- MarketSource (Alpharetta, GA)
- 121666BRTitle:Compliance ManagerJob Description: Compliance Manager (Insurance) MarketSource Inc., an Allegis Group Company, develops and delivers innovative managed ... Summary Responsible for leading a team and driving regulatory compliance and risk mitigation efforts through the organization, by identifying risk areas… more
- Deloitte (Baltimore, MD)
- …Medicaid waivers (ie, 1115, 1915 b/c, 1332) + 1+ years experience with risk adjustment mechanisms + 1+ years experience with Provider reimbursement streams ... October 31, 2024. Work you'll do As a Deloitte Consulting Health Actuary Manager in Deloitte's GPS Human Capital Actuarial and Insurance Solutions Practice, you will… more
- Deloitte (Columbus, OH)
- …product strategy + Reimbursement models - including value-based care/ACO modeling + Risk adjustment mechanisms + Familiarity with group insurance products ... Work you'll do As a Deloitte Consulting Health Actuary Manager in the Insurance practice of Deloitte's Human Capital...& Insurance Solutions practice works with finance, actuarial, and risk functions to help life insurance companies, property &… more
- Marshfield Clinic (Marshfield, WI)
- …internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ... ensure the accuracy and integrity of risk adjustment data submitted to the Centers... data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services… more
- Billings Clinic (Billings, MT)
- …Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Case Manager II or Therapist (.6) PSYCH STABILIZATION ... * Provides crisis intervention, therapeutic support and coping skills on adjustment to illness/disability. * Identifies physical, psychosocial, and spiritual needs… more
- Tufts Medicine (Boston, MA)
- …aligned with the Hospital Quality and Equity Incentive Program of the Massachusetts Medicaid 1115 Waiver. This work will spread across the Tufts Medicine Health ... Medical Officer for Quality, the Melrose Wakefield Hospital Senior Director Quality, Risk Management & Patient Safety and the Lowell General Hospital Vice President,… more
- Healthfirst (NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), ... the impact of provider reimbursement changes. + Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital… more
- Hartford HealthCare (Farmington, CT)
- …and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. Reporting ... to Manager of Audit and Education *_Position Responsibilities:_* *Key Areas...6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... + Contribute towards the maintenance and enhancement of an effective Compliance Risk Assessment Program + Project manage regulator and other external reviews as… more
- FlexStaff (Jamaica, NY)
- …and full capture of the burden of illness of our participants and appropriate risk adjustment . Provide feedback and counseling to DTC and IDT staff regarding ... collaborate with a Social Worker, Admin Support/Driver, and Account Manager to deliver care to patients in the Jamaica,...frail and/or elderly. For participants with higher levels of risk , these assessments will be performed more frequently to… more
- Baystate Health (Springfield, MA)
- …compassionate care to our patient population. Reports directly to the manager of Transplant Services. Collaborates with the designated transplant multidisciplinary ... patient record in accordance with agency policy. Familiarizes self with Medicare/ Medicaid and other third-party guidelines and eligibility requirements + Clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …and/or maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... performance indicators. **Additional Responsibilities** + Support Corrective Action Plan (CAP) Manager in communicating on new and existing CAPs emerging from source… more