- 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 specifications +… more
- 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 specifications +… 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 analytical processes, investigation and interpretation of CMS risk score… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk ... Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance,… more
- Molina Healthcare (Roswell, NM)
- …and development ad-hoc as well as automated analytical modules related to Risk Adjustment for Medicaid, Marketplace and Medicare /MMP. + Assist Risk ... **Job Description** **Job Summary** The Lead, Risk Adjustment - Predictive Analytics role...least one line of business among Medicaid, Marketplace and Medicare /MMP. + 5+ Years of experience in Prospective/Retrospective/Audit targeting… more
- Humana (Miramar Beach, FL)
- …+ Experience with public speaking and presentation skills with healthcare providers + Medicare Risk Adjustment knowledge **Additional Information** Work at ... 4 or more years of medical coding experience + Risk Adjustment knowledge + Proficiency with data...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years.… more
- Humana (Concord, NH)
- …(CRC) + Experience interacting with healthcare providers + Ability to work independently + Medicare Risk Adjustment knowledge + Analyzing data to build ... provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes data and… 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
- Hartford HealthCare (Farmington, CT)
- …documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the ... documentation practices that comply with CMS on evaluation and management, procedure, risk adjustment program requirements and ICD 10 coding guidelines.… 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
- Humana (Greenville, SC)
- …exceptional follow up skills + Valid Driver's license and reliable transportation + Medicare Risk Adjustment knowledge **Additional Information** Work at ... leadership, webinars public speaking and/or presentation skills with healthcare providers + Risk Adjustment knowledge + Familiar with coding guidelines + Live… more
- Humana (Phoenix, AZ)
- …leaders and their respective functions with a focus on Provider Engagement, Quality and Medicare Risk Adjustment . The RVP, Network Performance represents the ... is responsible for the overall success of Stars and Risk Adjustment strategy and performance within a...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Centene Corporation (Jefferson City, MO)
- …+ 3+ years Audit, risk adjustment and/or compliance required + Risk Adjustment /HCC coding required + Medicare experience required + Demonstrated ... from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the… 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 ... and life experiences to realize our bold vision for healthcare. The Risk Adjustment Sr Data Analyst is an experienced analyst possessing a deep understanding… more
- Ascension Health (Austin, TX)
- …+ 3-5 years Medical Coding experience with at least 2 years specific to Medicare Risk Adjustment /HCC Coding required. + ICD-10 coding experience required. ... the following from AAPC and/or AHIMA: Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Professional Medical Auditor (CPMA),… more
- CenterWell (Salt Lake City, UT)
- …Value Based Care contracts. + Experience in MSO, Payor Org. + Experience in Medicare Risk Adjustment , Cost Management, Utilization Management. + Advanced ... administrative expenses, and quality/bonus performance + Comprehensive knowledge of Medicare policies, processes, and procedures **Additional information** + Remote… more
- Point32Health (Canton, MA)
- …will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product ... Point32Health (https://www.point32health.org/) . **Job Summary** This position will lead the Risk Adjustment Operations & Provider Consulting team responsible… 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 ... Shift:** Mon-Fri; 8:00 am - 5:00 pm (United States of America) **Job Description:** The Risk Adjustment Revenue Manager is responsible for risk adjustment… 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...supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA markets. This role ensures… more
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