- 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
- Elevance Health (Richmond, VA)
- …and performs very complex actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + ... an equivalent background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience is strongly… more
- Independent Health (Buffalo, NY)
- …implementation of successful activities that improve the accuracy of the CMS risk adjustment scores of the Medicare Advantage membership. This role will ... Understanding of regulatory requirements as they relate to Medicare Advantage HCC risk adjustment . + Skill in organizing resources and establishing… 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 ... identifying opportunities to support precise clinical documentation. Collaborating with the Risk Adjustment and Quality teams, you'll help shape educational… more
- Humana (Columbus, OH)
- …other applied statistical methods + Strong communication/presentation skills **Preferred Qualifications** - Medicare Advantage risk adjustment experience ... involves developing deep subject matter around Medicare Advantage payments, with a focus on risk adjustment . The role examines public policy, including… more
- CenterWell (Columbus, OH)
- …outcomes + Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- CareOregon (Portland, OR)
- … risk adjustment coding and provider education programs for the Medicare Advantage and Medicaid product lines. This function is highly visible, matrixed ... Job Title Risk Adjustment Coding Manager Requisition #...materials. + Maintain an expert level of knowledge of Medicare and HCC risk -based reimbursement methodologies, policies… 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
- Robert Half Office Team (St. Louis, MO)
- … Billing, Medicare Claim, Medicare Risk Adjustment , Medicare Supplements, and Medicare Advantage . * Carrying out audits in the healthcare ... * Experience with Medicare Billing, Medicare Claim, Medicare Risk Adjustment , Medicare Supplements, and Medicare Advantage * Familiarity… more
- Amazon (San Francisco, CA)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... TME performance compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data primarily -Medical… more
- Highmark Health (Columbus, OH)
- …and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team… more
- WelbeHealth (Los Angeles, CA)
- …Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage /Part D payment models + ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… more
- Martin's Point Health Care (Portland, ME)
- …projects involving utilization management, Care Management, Medical Expense, Provider Engagement and Risk Adjustment have a robust plan and meets set deadlines ... monitor programs and manage success, including ROI, of programs. + Experience in Medicare Advantage and TRICARE preferred. + Experience in evaluating financial… more
- New York State Civil Service (NY)
- …Crisis Team. The incumbent will serve as a regional forensic liaison, providing risk assessments, evaluations for transition planning, and serve in a monitoring role ... OPWDD eligibility, access to services, waiver and CCOenrollment.* Perform forensic, risk , and other psychological assessmentsincluding but not limited to:o Various… 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
- Bloom Healthcare (Lakewood, CO)
- …needs and document these findings to support BI-centric solutions, particularly with Medicare Advantage , ACO, and claims data. + Build compelling visualizations, ... share insights to drive performance improvement, such as, MLRs, risk adjustment and quality measures. + Utilize...informatics, or a related field, preferably working at ACOs, Medicare Advantage payors, or value-based care programs… more
- Deloitte (Charlotte, NC)
- …+ 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 (Thiells, NY)
- …education.PRIMARY DUTIES AND RESPONSIBILITIES:* Monitor the need of high nutritional risk individuals in their assigned area (ie, tube feeding, pre-tube feedings, ... employee.* Please note that starting salary for this title reflects the downstate adjustment . Posted Hiring Salary includes the sum of the statutory hiring rate for… more