- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and execute of strategies, programs, and projects ... regulatory and CMS compliance requirements. You will manage the coding consultants who provide audit, coding expertise,...will also serve as a Subject Matter Expert for Medicare Advantage risk adjustment. Salary offers are… more
- The Cigna Group (Baltimore, MD)
- …Registered Health Information Management Technician (RHIT) + 5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan ... in addition to base salary._** This role is responsible for supporting Cigna Medicare Advantage 's Risk Adjustment program for assigned populations in an… more
- CareOregon (Portland, OR)
- …healthcare, claims, data management, EDI experience Preferred + Experience with Medicare Advantage risk adjustment and payment methodologies Knowledge, Skills ... hired for remote positions must reside in Oregon or Washington. Job Title Medicare Encounter Data Analyst Exemption Status Exempt Department Finance Manager … more
- The Cigna Group (Bloomfield, CT)
- …ORLANDO AND TAMPA** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage 's Risk Adjustment & Stars program for assigned populations ... role will work directly with providers to assist in achieving accurate and complete coding documentation and addressing Stars gaps in care. The role will work under… more
- The Cigna Group (Baltimore, MD)
- …Components** All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: + ... with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + Required - Microsoft Outlook, Excel, PowerPoint,… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …for internal and external use. Designated staff may focus primarily on supporting the Medicare Advantage line of business. **NATURE AND SCOPE** + This role does ... to regional offices and/or conferences and exhibits. + Staff dedicated to supporting Medicare Advantage must have working knowledge of Medicare enrollment… more
- Johns Hopkins University (Baltimore, MD)
- …national health system challenges, focusing on mental health and substance use services, Medicare (traditional and Medicare Advantage ), post-acute care, and ... markets, organizations, populations, and technologies. The platform houses Centers for Medicare & Medicaid (CMS) health insurance claims data and is integrating… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Prospective Payment Systems and Correct Coding Initiative + Experience in Medicare Advantage Plan, managed care or government contractor (eg: ZPIC, UPIC, ... medical terminology, ICD-9-CM, ICD-10-CM, HCPCS Level II and CPT coding along with analysis and processing of Medicare...assigned to the Operations area, as well as the Manager of FWA and VP of Administration + Meet… more
- Sharp HealthCare (San Diego, CA)
- …Rights. More fields may be added as regulations change.In cases where Tricare or Medicare / Medicare Advantage is primary or secondary, use scripting to review ... Medicare and Medi-Cal regulations. + Knowledge of ICD-10, CPT, and/or RVS coding . + Knowledge of Medicare Important Message, Medicare Secondary Payor,… more
- VIP Care (Sarasota, FL)
- …hospital portal access, state licenses, and professional memberships + Ensure compliance with Medicare Advantage Plans, HIPAA, and labor laws and is responsible ... passion and elevates your skills. Position Objective: The Office Manager is an operational and clinical role and is...read and write medical terminology + Knowledge of medical coding + Knowledge of HIPAA + Knowledge and understanding… more
- VIP Care (Estero, FL)
- …referral requests, patient records, and medication management + Ensures compliance with Medicare Advantage Plans, HIPAA, labor laws and is responsible for ... THE OPPORTUNITY VIPcare is searching for a Clinical Office Manager (CMA, RMA, MA) to provide preventative and chronic...read and write medical terminology + Knowledge of medical coding + Knowledge of HIPAA + Basic computer skills,… more
- CenterWell (Phoenix, AZ)
- …+ Medicare Provider Number/ Medicaid Provider Number + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... manner working with a quality- based coder to optimize coding specificity. + Follows policy and protocol defined by... Provider Number/ Medicaid Provider Number + Experience managing Medicare Advantage panel of patients with understanding… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Medical Mutual' ... cross-functional Scrum team under the direction of the IT Manager . Translates user stories and customer acceptance criteria of...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and… more
- Molina Healthcare (Springfield, IL)
- …related to utilization management, pharmacy, quality of care, and correct coding . * Independently delivers training and presentations to assigned providers and ... member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider… more
- Molina Healthcare (Seattle, WA)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider ... issues related to utilization management, pharmacy, quality of care, and correct coding . * Conducts regular provider site visits within assigned region/service area.… more
- The Cigna Group (Westerville, OH)
- This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational region ... role will work under the direction of the Senior Manager - National Lead Provider Education to reach overall...payer or provider operations, CMS Risk Adjustment and HCC coding process and quality including Medicare Star… more
- UCLA Health (Los Angeles, CA)
- Description As a member of the Medicare Advantage Operations team, Business Data Analyst is instrumental in independently developing the detailed requirements ... Each employee must complete a FlexWork Agreement with their manager which will outline arrangement parameters and aids both...+ Minimum of five (5) years' experience in a Medicare or Managed Care environment managing enrollment, claims or… more
- CenterWell (Gastonia, NC)
- …Care has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality ... of two to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in… more
- VIP Care (Tampa, FL)
- …medical management and performance improvement strategies to ensure success in our existing ( Medicare Advantage ) as well as net new LOBs. They will also ... + Experience in Utilization Management and Physician Improvement Programs + Experience in Medicare Advantage + Experience in Value-Based model of care +… more
- CenterWell (Marietta, GA)
- …of two to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... manner working with a quality- based coder to optimize coding specificity. + Follows policy and protocol defined by...in a value based relationship environment + Knowledge of Medicare guidelines and coverage + Bilingual is a plus… more