- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk Adjustment Coder (CRC) ... certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance, and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of...and MS Access Database. + Experience with EDGE & ACA or Medicaid risk score methodology, including… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …expertise in Risk Adjustment and healthcare data-primarily Medicare Advantage, Medicaid, and ACA Commercial-identifying trends and communicating insights ... enterprise. The ideal candidate will have experience in Risk Adjustment methodologies, clinical coding, and healthcare programs ( Medicare Advantage,… more
- CareFirst (Baltimore, MD)
- …to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA , and state-specific regulations. Remain current on changes to ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA markets. This… more
- Datavant (Honolulu, HI)
- …improve productivity and quality.** + Run various risk adjustment models for Medicare Advantage, Medicaid or ACA to forecast patient risk scores and ... experiences to realize our bold vision for healthcare. The Risk Adjustment Sr Data Analyst is an...Python, etc. + **_Deep understanding of and experience in Risk Adjustment_** (MA, ACA and MD) business… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk adjustment ... the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of...and problem resolution to meet business operational requirements for Medicare Advantage(MA), Affordable Care Act ( ACA ) &… more
- Highmark Health (Cheyenne, WY)
- …Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team ... in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act ( ACA...leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient… 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 , ... BIDs, Data Engineers, Data Scientists, and internal/external customers. Essential Functions + Risk Adjustment Analytics & Reporting + Develop and deliver… more
- Highmark Health (Pittsburgh, PA)
- …**Quality & Risk Management** : Strategically develop STARS/Quality and Risk Adjustment initiatives across the Government Business segment, driving ... ACA and Senior Markets, Group and Direct Pay Medicare Advantage, Direct Pay Medicare Supplemental and...Stars ratings, and ensuring the accuracy and completeness of risk adjustment data to maximize revenue and… more
- Sutter Health (Sacramento, CA)
- …contracts, ensuring accurate setup in collaboration with Operations and MCF.** + **Validate CMS Medicare Advantage and ACA risk scores, along with payer ... finance foundation and solid understanding of provider reimbursement principles-such as risk adjustment , capitation, and fee-for-service-who can apply this… more