- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter ... Expert (SME) for risk adjustment with contracted IPAs + Collaborating...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage , STARS/HEDIS program, and NCQA technical… more
- VNS Health (Manhattan, NY)
- …medical records, including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required + 2 years of ... areas of opportunity to support accuracy clinical documentation. Works with Risk Adjustment and Quality team to identify topics, areas and opportunities for… more
- Banner Health (AZ)
- …responsible for understanding and serving as an informative source on Medicare Advantage funding models ( Risk adjustment , HCCs, HEDIS quality Rate, etc.) ... Population Health goals and initiatives. The RN will assist with chart reviews, risk adjustment prep, patient out reach for Medicare Annual Wellness visits,… more
- Molina Healthcare (Columbus, OH)
- **Job Summary** As the leader for Molina's Medicare Advantage product (Non-Dual), this position has P&L, business strategy, sales distribution and provider ... with senior leadership, determines the annual implementation of Molina's Medicare Advantage product strategic plan. + Has... operations as they relate to compliance, operations, Stars, risk adjustment , network Design, and quality. +… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. _Collaborates ... with internal departments on risk adjustment coding strategies, HEDIS performance, provider...Medicare & Medicaid Services (CMS) regulations pertaining to Medicare Advantage and Affordable Care Act.** +… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Medical Mutual' ... Compliance Specialist I** Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care... coding for ACA (Affordable Care Act) and MA ( Medicare Advantage ) with assigning and maintaining diagnoses… more
- AdventHealth (Maitland, FL)
- …on all contracts and business lines, including Direct-To-Employer, Commercial, ACA Exchange, Medicare , Medicare Advantage , Bundles, and other Network ... improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o...both for clinical quality and financial performance across the Medicare , Medicare Advantage , and Exchange… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Medical Mutual' ... of life. **Responsibilities** **Medical Record Retrieval Specialist** Supports the company's risk adjustment projects by collaborating with vendors and provider… more
- CVS Health (Overland Park, KS)
- …root-cause analyses, and manage the risk position of various value-based products ( Medicare Advantage , MSSP, ACO REACH).** **What will you do?** + Evaluate ... the impact of Medicare quality and risk adjustment ...or a number of exams passed -Strong knowledge of Medicare Advantage products, ACO, MSSP, ACO REACH… 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 ) ... precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA....self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- CenterWell (Frankfort, KY)
- …outcomes & performance . Expertise in value-based care, especially Medicare Advantage , with familiarity of HEDIS/STARS, medical risk adjustment , and ... and outcomes **Preferred Qualifications** . A passion for serving high- risk seniors in achieving their best health and outcomes...and outcomes . Understanding of health plan frameworks in Medicare Advantage and managed care that affect… more
- Novant Health (NC)
- …Quality, Total Cost of Care, Network Integrity, Social Determinants of Health, Risk Adjustment , and Attribution. + Build compelling visualizations, innovative ... performance opportunity identification. + Maintain a working knowledge of Medicare , Medicaid, and commercial insurance products and value-based care incentive… more
- Deloitte (Minneapolis, MN)
- …Experience with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, ... of the individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for… more
- Deloitte (Stamford, CT)
- …+ Experience with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with health care reform and working ... of the individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for… more
- Atlantic Health System (Morristown, NJ)
- …filings + Responsibility for supplemental submission of Medicare Risk Adjustment Files associated with Medicare Advantage plans. + Coordination and ... performance across payer lines of business + Engage in assessments of MSSP - Medicare Shared Savings Program participation as required by the ACOs. + Communicate and… more
- New York State Civil Service (Wassaic, NY)
- …for providing opportunities for employment to special populations and individuals with high- risk behaviors who cannot be served by voluntary agency programs. The ... status.* Please note that starting salary for this title reflects the Mid-Hudson adjustment . Posted Hiring Salary includes the sum of the statutory hiring rate for… more
- Amergis (San Antonio, TX)
- …Auditing Experience (Required) + Minimum of three (3) years of HCC/ Risk Adjustment Coding Experience + Strong Experience in Medicare Advantage (Required) ... + System use: E-Clinical Works (ECW) + Schedule: Normal Business Hours + Reliable Transportation due to this being a Hybrid Role (San Antonio, TX) + Must be at least 18 years of age Benefits At Amergis, we firmly believe that our employees are the heartbeat of… more
- New York State Civil Service (Thiells, NY)
- …and monitor functional behavior assessments and behavior support plans (or higher- risk behavior support plans for anyone with forensic background) for individuals ... Informed Consent Committees (ICC) for approval. Present plans to Risk Management Committee if anyone has a Higher ...program listed on the official transcript. Additional Comments *Downstate Adjustment of $3,400 has been added to hiring rate/job… more
- Trinity Health (Columbus, OH)
- …**Shift:** **Description:** **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other ... Insurance License (Life and Health) or obtained within 90 days of hire. Risk Adjustment department: None + Experience: One to three years experience preferred in… more