- 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...RxHCC, HHS-HCC and CDPS + **_Intermediate proficiency in SQL ( advanced analytic queries), Python (data manipulation and automation, streamlit,… more
- Humana (Salt Lake City, UT)
- …part of our caring community and help us put health first** The Manager, Risk Adjustment conducts quality assurance audits of medical records and ICD-9/10 ... Medicare and Medicaid Services (CMS) and other government agencies. The Manager, Risk Adjustment works within specific guidelines and procedures; applies … more
- CenterWell (Salt Lake City, UT)
- …in MSO, Payor Org. + Experience in Medicare Risk Adjustment , Cost Management, Utilization Management. + Advanced organizational skills and/or project ... administrative expenses, and quality/bonus performance + Comprehensive knowledge of Medicare policies, processes, and procedures **Additional information** + Remote… 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
- Convey Health Solutions (Fort Lauderdale, FL)
- …and consumption including but not limited to eligibility, claims, payments and risk adjustment . The Senior Data Engineer supports Pareto Operations. Key ... with healthcare data, including but not limited to eligibility, claims, payments, and risk adjustment datasets. + Expertise in modeling data in relational… more
- Humana (Tallahassee, FL)
- …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... and relationship builder, ensuring alignment with Humana's mission and Medicare Advantage goals. **Primary Responsibilities:** Clinical Engagement & Provider… more
- Harvard University (Cambridge, MA)
- …research related to aspects of the Medicare program, including payment policy, risk adjustment , and competition. Experience working with Medicare claims ... and SAS or Stata) * Demonstrated expertise in causal inference and high-dimensional risk adjustment /predictive modeling, experience with Medicare claims data… more
- CenterWell (Tampa, FL)
- …a value-based primary care setting. This role uses clinical expertise and knowledge of risk adjustment and coding to present educational materials in a way that ... clinicians, presenting education that aligns with value-based care priorities like risk adjustment accuracy, quality performance, compliance, and effective… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …internal and external to ensure accuracy. Supervises reporting, valuation, and forecasting of risk adjustment score and revenues to support partners internal and ... adjudication and reporting. + Provides input into product development process. + Projects risk adjustment factors, model impacts of potential payment changes. +… more
- Molina Healthcare (Atlanta, GA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... ability to convert observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other… more
- St. Luke's University Health Network (Bethlehem, 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …and external to ensure accuracy. Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and ... experience supervising or managing people and/or projects or indirectly leading teams. + Advanced knowledge of financial and risk health arrangements. + Strong… more
- St. Luke's University Health Network (Sellersville, 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
- Deloitte (Los Angeles, CA)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- SSM Health (MO)
- …scoring. + Collaborates with others regardingclinical documentation improvement (CDI) and risk adjustment (mortality) findings. + Maintains knowledge of Centers ... the current health status of network patients against ever-changing risk adjusted models. Responsible for achieving improved documentation results...for Medicare and Medicaid Services (CMS) requirements related to clinical… more
- Humana (Alachua, FL)
- …community and help us put health first** The Medical Record Retrieval Specialist ( Risk Adjustment Representative 3) Travels to provider offices within the region ... The records are reviewed by Humana's Coding staff. The Medical Record Retrieval Representative ( Risk Adjustment Representative 3): + Travel up to 60% of the time… more
- Sutter Health (Sacramento, CA)
- …finance foundation and solid understanding of provider reimbursement principles-such as risk adjustment , capitation, and fee-for-service-who can apply this ... ensuring accurate setup in collaboration with Operations and MCF.** + **Validate CMS Medicare Advantage and ACA risk scores, along with payer codes, for… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment , Stars performance, and member engagement. Pareto's deep ... A keen eye for details, passion for serving the unique needs of the Medicare population, and critical-thinking and communication skills will be the keys to success… more
- Humana (Jefferson City, MO)
- …+ Partnership & Engagement + Serve as a key liaison with partners in Risk Adjustment and other enterprise teams to align priorities, communicate progress, and ... advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience. _A high-performing, independent role dedicated to tackling… more
- Virginia Mason Franciscan Health (Silverdale, WA)
- …the Masters Social Worker include: crisis intervention, patient/family intervention, high- risk screening, brief counseling, referrals for financial or other ... discharges and engagement of appropriate agencies or community resources when high- risk patients are identified. **Essential Key Job Responsibilities** 1. Providing… more
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