- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Specialist, you will be responsible for: + Serving as a Subject Matter Expert ... (SME) for risk adjustment with contracted IPAs + Collaborating...of health plan experience, highly desired + Knowledge of Medicare Advantage, STARS/HEDIS program , and NCQA technical… 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...CPT (II), and HCPCS coding systems + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- Point32Health (Canton, MA)
- … adjustment engagement with senior leaders at contracted provider organizations. + ** Risk Adjustment Program Management and Vendor Evaluation** : The ... provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare ,...Manager will be responsible for risk adjustment program management and… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Manager (Remote) **Cost Center:** 682891390 SHP-Strategic Finance ... 5:00 pm (United States of America) **Job Description:** The Risk Adjustment Revenue Manager is responsible for...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- CareFirst (Baltimore, MD)
- …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...Adjustment . + Successful completion of a Coding Certificate program from an accredited organization (ie, CPC, CRC, CPMA… more
- Trinity Health (Columbus, OH)
- **Employment Type:** Full time **Shift:** **Description:** The Risk Adjustment Coder is responsible for reviewing and abstracting medical records to ensure ... accurate and complete diagnosis coding for risk adjustment purposes. This includes validating documentation...to date CPC certification preferred + Completes and submits Medicare Patient Assessment Forms and maintains accurate database of… more
- CareFirst (Baltimore, MD)
- …**Knowledge, Skills and Abilities (KSAs)** + Deep knowledge of regulatory compliance and risk adjustment program integrity. + Experience developing & ... **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes...and problem resolution to meet business operational requirements for Medicare Advantage(MA), Affordable Care Act (ACA) & Medicaid Lines… more
- Centene Corporation (Jefferson City, MO)
- …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... risk adjustment and/or compliance required + Risk Adjustment /HCC coding required + Medicare...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- Datavant (Honolulu, HI)
- …work to partner with the teams to improve productivity and quality.** + Run various risk adjustment models for Medicare Advantage, Medicaid or ACA to ... experiences to realize our bold vision for healthcare. The Risk Adjustment Sr Data Analyst is an...for analysis and assumptions to provide data-driven insights into program performance and partnerships + Create clear and concise… more
- Humana (Jefferson City, MO)
- …a part of our caring community and help us put health first** The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ... Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Representative 2 performs varied activities and moderately complex… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and vendor performance relative to established contracts. * Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply broad actuarial...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Emanate Health (Covina, CA)
- …and billing staff to ensure accurate documentation, coding compliance, and optimal risk adjustment outcomes. The HCC Coding Specialist ensures the IPA's ... Risk Adjustment Factor (RAF) maintains or exceeds... Risk Adjustment Factor (RAF) maintains or exceeds 1.0 and supports...Experience Requirement: Minimum of one (1) year experience in Medicare HCC program within IPA, HMO, or… more
- Molina Healthcare (Iowa City, IA)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives ... Practice Transformation plan is in place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** + Ensures assigned Tier 2 &… more
- Amazon (San Francisco, CA)
- …economics reporting and ad-hoc analysis relating to cost of care management - Medicare Risk score projections and premium estimation -Design and implement ... -Value based care contracting support and ongoing financial and risk analysis. -Support ongoing actuarial support for outside auditor...in value-based care, including CMS initiatives such as the Medicare Shared Savings Program (MSSP) and ACO… more
- Corewell Health (Grand Rapids, MI)
- We are seeking a highly analytical and detail-oriented Risk Adjustment Reporting Developer to support our organization's Medicare Advantage, ACO, ACA, and ... BIDs, Data Engineers, Data Scientists, and internal/external customers. Essential Functions + Risk Adjustment Analytics & Reporting + Develop and deliver… more
- Centene Corporation (Harrisburg, PA)
- …related experience including quality improvement, HEDIS operations, and Risk Adjustment . Experience with quality rating systems, Medicare products, ... best practices towards achieving market and product quality and risk goals + Serve as subject matter expert in...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- Hartford HealthCare (Farmington, CT)
- …support documentation practices that comply with CMS on evaluation and management, procedure, risk adjustment program requirements and ICD 10 coding ... documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the… more
- Hartford HealthCare (Farmington, CT)
- …observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition ... Documentation Integrity (CDI) by providing day-to-day oversight of the program . They also represent and support CDI at the...capture (HCC) codes, risk adjustment , and other high quality documentation outcome measures. .… more
- CenterWell (Indianapolis, IN)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... improvement and coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and modeling and driving… more
- CenterWell (Orlando, FL)
- …Coding Curriculums. In this role, you'll blend your clinical expertise-especially in Medicare Risk Adjustment (MRA) and HCC coding-with instructional ... + Design and develop provider education programs focused on clinical documentation, risk adjustment , and coding accuracy for value-based primary care. +… more