- Elevance Health (Hanover, MD)
- ** Risk Adjustment Advanced Analyst Senior** **Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 ... one of our Elevance Health PulsePoint locations.** **Preferred Location:** Hanover, MD. The ** Risk Adjustment Advanced Analyst Senior** is responsible for… more
- The Cigna Group (Denver, CO)
- **Summary** The Medicare Risk Adjustment Advanced Analytics team is searching for a highly motivated and collaborative person to build new data ... and enable analytics. You will work closely with colleagues across the Risk Adjustment business, data science, and data analytics teams to develop new assets,… more
- The Cigna Group (Houston, TX)
- **Summary** The Medicare Risk Adjustment Analytical Consulting team is searching for a highly motivated and collaborative business analytics advisor to ... decision-making. You will work closely with colleagues across the Risk Adjustment business, data science, and data...from large and complex data sets + Experience in advanced analytics and data science a plus + Demonstrated… more
- VNS Health (Manhattan, NY)
- …to CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers ... evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief Summary of Purpose** : The primary role of the Risk Adjustment Analyst (RAA) will be to function as the Claims SME for ... be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for...the Risk Adjustment & Analytics Department. The RAAimplements… more
- Sutter Health (Sacramento, CA)
- …with program management in a healthcare or health plan setting. + Knowledge of risk adjustment program management. + Knowledge of health plan regulatory and ... agencies, such as the Department of Managed Health Care and Centers for Medicare and Medicaid Services. Develop and implement policies, standard work, processes, and… more
- CareOregon (Portland, OR)
- …years' healthcare, claims, data management, EDI experience Preferred + Experience with Medicare Advantage risk adjustment and payment methodologies ... Knowledge, Skills and Abilities Required Knowledge + Advanced knowledge of statistical software packages, such as SAS...statistical software packages, such as SAS + Knowledge of risk adjustment methodology and Medicare … more
- The Cigna Group (Birmingham, AL)
- …care capabilities for Accountable Care. This role will be responsible for executing advanced analytics around ACO/ Risk Bearing Entity programs to help measure ... and identify trends, variances, and key issues and provide recommendations for adjustment + Prepare and improve financial analysis and forecasting methodologies +… more
- Highmark Health (Pittsburgh, PA)
- …Managed Care + 3 years in Budget Administration + Experience in leading Medicare Advantage risk adjustment strategies **LICENSES OR CERTIFICATIONS** ... with VP of Revenue Program Management in support of governmental products where Risk Adjustment methodologies apply. Functions as the business owner of the… more
- Independent Health (Buffalo, NY)
- …on pricing outcomes. + Establish and implement claims review processes to support risk adjustment . Analyze data and provide strategic insights to enhance pricing ... and financial performance. + Ensure compliance with CMS regulations and risk adjustment methodologies. + Develop and execute pricing strategies, incorporating… more
- The Cigna Group (Birmingham, AL)
- …completing deliverables. + Develops and maintains an advanced knowledge of Medicare Advantage risk adjustment and can articulate emerging developments ... a series of stakeholders on setting our risk adjustment strategy. Reporting to the Medicare Advantage Revenue Finance lead, this position will work within… more
- Bristol Myers Squibb (San Francisco, CA)
- …in their personal lives. Read more: careers.bms.com/working-with-us . **Dermatology APP ( Advanced Practice Practitioner) Liaison** **Location** : Field - US At ... make a difference. **Position Summary** Currently, we are seeking a Dermatology APP ( Advanced Practice Practitioner) Liaison in US Field . This is an opportunity to… more
- AdventHealth (La Grange, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care team). The Social Work Care… more
- Baylor Scott & White Health (Columbus, OH)
- **JOB SUMMARY** The Risk Adjustment Analyst Sr (Texas Medicaid Encounter Analyst) is responsible for monitoring and oversight of the end-to-end encounter ... management workflow. Supports program management activities around risk adjustment data management and submissions to...and submissions to government agencies such as Centers for Medicare and Medicaid Services (CMS) or Health & Human… more
- Commonwealth Care Alliance (Boston, MA)
- …and supporting systems. + ** Risk Adjustment ** Experience supporting Medicare risk adjustment programs, supporting systems, and data including ... of business processes, software systems, and technology platforms that support Medicare and Medicaid Health Plans. **Supervision Exercised:** + No, this position… more
- New York State Civil Service (Bedford Hills, NY)
- …counseling, etc. Duties Description Associate Psychologist functions as an advanced clinician and provide professional psychological services under the clinical ... substance and/or chemical abuse programs, specialized assessment (functional, personality, risk , competency, vocational, education); design and application of behavioral… more
- Intermountain Health (Las Vegas, NV)
- …physicians, advanced practice providers (APP), and other staff about documentation and risk adjustment in order to improve the accuracy of the overall ... mentor to leaders, physicians, APP's, and other staff about documentation and risk adjustment . + Reviews medical records documentation for reimbursement,… more
- Henry Ford Health System (Troy, MI)
- …Entities or APMEs) to secure provider performance improvement including HEDIS, Medicaid and Medicare Star rating program, risk adjustment data collection, ... TCOC budgets that recognize member medical demand through appropriate risk score recognition, general performance improvement initiatives (eg leakage avoidance)… more
- Actalent (Portsmouth, VA)
- …LPN role will include the provision of care coordination including Medicare Wellness Vitis, Chronic Disease Care Management, and Transitional Care Management ... for high risk patients. + Utilize excell spreadsheets to track pateints due for Medicare Wellness visits + Work with Medical Assistant and other practice team… more
- St. Luke's University Health Network (Easton, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more