- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor, you will be an expert in risk adjustment coding ... 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
- Somatus (Mclean, VA)
- …5 years of leadership/management experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven ... well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and… more
- The Cigna Group (Nashville, TN)
- …Manager is an opportunity to lead complex analytics projects and initiatives for Cigna's Medicare Advantage Risk Adjustment business. The Manager will ... of business analytics professionals. Reporting to the Senior Manager of Risk Adjustment Analytics, this position will manage the prioritization, intake, and… more
- Elevance Health (Indianapolis, IN)
- …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
- CareOregon (Portland, OR)
- …3 years' healthcare, claims, data management, EDI experience Preferred + Experience with Medicare Advantage risk adjustment and payment methodologies ... Advanced knowledge of statistical software packages, such as SAS + Knowledge of risk adjustment methodology and Medicare encounter data + Knowledge of … more
- Providence (OR)
- … Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical background + ... providing critical insights to enhance the performance of our Medicare Advantage plans **_Please note the following...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- Highmark Health (Pittsburgh, PA)
- …in Managed Care + 3 years in Budget Administration + Experience in leading Medicare Advantage risk adjustment strategies **LICENSES OR CERTIFICATIONS** ... VP of Revenue Program Management in support of governmental products where Risk Adjustment methodologies apply. Functions as the business owner of the risk… more
- The Cigna Group (Birmingham, AL)
- …and judgement when completing deliverables. + Develops and maintains an advanced knowledge of Medicare Advantage risk adjustment and can articulate ... risk adjustment strategy. Reporting to the Medicare Advantage Revenue Finance lead, this position...Prefer candidates with some familiarity of Medicare Advantage and risk adjustment . +… more
- The Cigna Group (Chattanooga, TN)
- …Reside in Chattanooga area** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage 's Risk Adjustment program for assigned ... of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It...risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred. +… more
- Conviva (Tallahassee, FL)
- …Coding Certification + Ability to Travel **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- CenterWell (Jackson, MS)
- …in business in business, healthcare administration, or related field. + Proven experience with Medicare Advantage risk adjustment functions + Proven ... across the function or segment. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing efficiency and… more
- Martin's Point Health Care (Portland, ME)
- …Ideal candidates are those who are coming from a Health Plan and with strong Risk Adjustment and Medicare backgrounds. Job Description 100Key Outcomes: + ... Work" since 2015. Position Summary The Vice President of Risk Adjustment works closely and collaboratively with...programs, and initiatives for Martin's Point Health Care Generations Advantage Medicare Advantage product. This… more
- The Cigna Group (St. Louis, MO)
- …least 3 days: Tuesday, Wednesday and other day of choosing)** **Summary:** The Stars and Risk Adjustment Operations Senior Advisor will report to the Stars and ... Risk Adjustment Managing Director and will be...gather materials for Stars and RA team meetings and Medicare leadership meetings: + Seniors Business Operating Review Monthly… more
- Martin's Point Health Care (Portland, ME)
- …to Work" since 2015. Position Summary **NEW REMOTE POSITION** The Senior Risk Adjustment Analyst analyzes data, reviews findings, and develops recommendations ... hoc reporting used in complex conceptual analyses for all departments within Risk Adjustment Operations + Develops systematic reporting processes and procedures… more
- Healthfirst (NY)
- …of businesses, such as finance, clinical, medical economics, operations, risk adjustment , and population health strategy to implement Medicare strategies and ... institution + Extensive knowledge and experience in one or more the following Medicare Advantage performance areas: + Risk Score Accuracy + Medicare … more
- The Cigna Group (Denver, CO)
- …conduit to the providers and the individual that represents Cigna Medicare Advantage . The Provider Performance External Representative's responsibilities ... but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. +...members contribute to the growth and profitability of the Medicare Advantage business in their market in… more
- Healthfirst (NY)
- …lines of businesses, including finance, clinical, medical economics, risk adjustment , and population health strategy implement Medicare strategy for ... Excel skills + Strong understanding of the healthcare industry marketplace, specific to Medicare Advantage + Self-motivated and driven + Understand and translate… more
- Humana (Albany, NY)
- …This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the expansion and support for ... focused in the areas of Provider Contracting, Provider Engagement and Quality, Risk Adjustment , Clinical, and Financial Operations. + Leadership development,… more
- The Cigna Group (Atlanta, GA)
- …(which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, Provider Relations, and ... and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance...members contribute to the growth and profitability of the Medicare Advantage business in their market in… more
- The Cigna Group (Maitland, FL)
- …Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment , Finance, Marketing, Cross-Segment Contracting, Provider Relations, ... relationships in order to drive optimal performance on Stars, risk adjustment , utilization management, and overall financial...members contribute to the growth and profitability of the Medicare Advantage (MA) business in their market… more