- CareFirst (Baltimore, MD)
- …to developing materials and presenting key updates to leadership regarding risk adjustment programs and provider and member engagement initiatives. + ... solve problems, provide data-driven guidance, and monitor risk adjustment performance. Provide analytical...key deliverables. Develop tracking and monitoring mechanisms for all Risk Adjustment and Coding programs .… more
- UCLA Health (Los Angeles, CA)
- …with leadership surrounding mock RADV audits + Assist in developing work flow for risk adjustment activities and programs + Participate in meetings to ... can do all this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment … more
- Elevance Health (Atlanta, GA)
- **Business Change Director - Risk Adjustment Data Quality** **Alternate locations may be considered:** This position will work in a hybrid model (remote and ... of one of our Elevance Health PulsePoint locations. The **Business Change Director for Risk Adjustment Data Quality** will serve as a strategic partner for the… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , 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 plan. You will: + Conduct medical record audits… more
- Centene Corporation (Raleigh, NC)
- …and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of ... which includes implementation of elements of an effective compliance program . Oversees the development of risk assessments...assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to… more
- Centene Corporation (Phoenix, AZ)
- …travel to areas surrounding Tempe and Tucson, Arizona. **Position Purpose:** Utilize risk adjustment methodologies, principles, and knowledge of managed care ... organizations to increase engagement in provider performance programs utilizing data to develop...Develop collaborative relationships with providers to educate and improve Risk Adjustment coding and documentation competencies. +… more
- Medical Mutual of Ohio (OH)
- …and perform pre-employment substance abuse and nicotine testing._ **Title:** _Risk Adjustment Provider Programs Specialist_ **Location:** _Ohio_ ... plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance,...as project manager over large internal risk adjustment projects (eg, Optum In Office Assessment program… more
- Elevance Health (Indianapolis, IN)
- ** Risk Adjustment Senior Data Reporting Analyst** **Location:** This position will work a hybrid model (remote and office). The Ideal candidate will live within ... our Elevance Health Pulse Point locations. **Preferred Location:** Indianapolis, IN. The ** Risk Adjustment Senior Data Reporting Analyst** is responsible for… more
- MedKoder (Mandeville, LA)
- …hands-on production). Must have at least 1 year of specialized experience in Medicare Risk Adjustment disciplines- such as HCC, CCC HEDIS + Auditing experience a ... on a consistent basis + Attend conference calls as necessary to provide information and/or feedback Education/Experience Requirements: + Successful completion of at… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: RMRA (Revenue Management Risk Adjustment ) Health Risk Coding and Education Specialist - Level II, specific to the Risk Adjustment ... coordination, documentation and coding of CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) and vendor...+ Completes outreach and engagement activities to the HAP provider network. + Provides detailed health risk … more
- Molina Healthcare (OH)
- …& ABILITIES:** * 4+ years of program and/or project management experience in risk adjustment and/or quality * 4+ years of experience supporting HEDIS engine ... limited to: Risk /Quality rate trending and forecasting; provider Risk /Quality measure performance, CAHPS and survey...activity, risk adjustment targeting and reporting systems *… more
- Molina Healthcare (Kenosha, WI)
- …& ABILITIES:** * 8+ years of program and/or project management experience in risk adjustment and/or quality * 4-6 years of experience supporting HEDIS engine ... limited to: Risk /Quality rate trending and forecasting, provider Risk /Quality performance, CAHPS and other survey...activity, risk adjustment targeting and reporting systems *… more
- Healthfirst (NY)
- …and Responsibilities** + Assume leadership role in the delivery and execution of the risk adjustment program by driving value through data driven decisions ... for quantitative analysis + Minimum ten (10) years' experience in a combination of quality, provider engagement and/ risk adjustment , with at least 3 years in… more
- Molina Healthcare (NM)
- …& ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of experience supporting HEDIS engine ... limited to: Risk /Quality rate trending and forecasting; provider Risk /Quality measure performance, CAHPS and survey...activity, risk adjustment targeting and reporting systems *… more
- VNS Health (Manhattan, NY)
- …provider education programs . + Designs and develops teaching plans and program content for provider education and ensure it meets contractual and ... of opportunity to support accuracy clinical documentation. Works with Risk Adjustment and Quality team to identify...in new/changes to regulations. + Reviews and evaluates ongoing provider education programs to identify areas for… more
- Henry Ford Health System (Troy, MI)
- … community improve with accurate submission of clinical documentation and coding of risk adjustment data through a combination of education and engagement ... using the Altegra RiskView systems for both Medicare Advantage Risk Adjustment and Healthcare Reform Risk...of this activity. + Trains and lead coding and provider education staff and provide lead oversight… more
- Medical Mutual of Ohio (OH)
- …**Medical Coding Compliance Specialist I** Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA ... the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million...precise medical codes. Audits vendors for quality assurance of risk adjustment coding for ACA and MA.… more
- Molina Healthcare (WA)
- …Quality/HEDIS measures, HEDIS Operations, Data Management and Reporting, Risk Adjustment and Value Based Care. Manages assigned provider relationships across ... **Job Description** **Job Summary** The Program Manager, Provider Engagement Programs...with contracted vendors and colleagues to develop and implement provider education/engagement in risk adjustment … more
- Molina Healthcare (NV)
- … Provider Quality contributes to one or more of these quality improvement/ risk adjustment functions: + Implements key quality and population health strategies ... new and existing healthcare quality improvement initiatives and education programs specific to the Provider Network; ensures...and risk adjustment , alongside providers and with direction… more
- Fallon Health (Worcester, MA)
- …strive to be the leading provider of government-sponsored health insurance programs -including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for ... coded * Assist in the collection and analysis of risk adjustment data in-order to identify documentation,...records to increase the accuracy, clarity and specificity of provider documentation. * Provide feedback to providers… more