- 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...Five or more years of experience in healthcare analytics, strategy , and/or consulting at an IPA or health plan… more
- Point32Health (Canton, MA)
- …and business division goals. This position will report to the Director of Risk Adjustment Strategy , Operations and Quality Assurance. **Job Description** ... will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product… 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
- Marshfield Clinic (Marshfield, WI)
- …Description:** The Risk Adjustment Revenue Manager is responsible for risk adjustment strategy and related revenue management for Security Health ... Plan's Medicare , Affordable Care Act and Medicaid business. This individual...Clinic Health System (MCHS) executives and leadership to lead risk adjustment strategy and process.… more
- CareFirst (Baltimore, MD)
- … Manager plays a critical role in the development and execution of the corporate risk adjustment strategy . The role serves as a dedicated resource within ... the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading... strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations… 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...Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA… 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... Data Analytics Leaders in Prospective and Retrospective Intervention Strategy Analytics along with corresponding tracking of progress and… more
- Molina Healthcare (OH)
- …Azure, AWS, or Hadoop + 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment + 3-5 years of experience in working with complex data to ... Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare...users on how to use reports + Builds intervention strategy reporting for the Risk and Quality… more
- Centene Corporation (Harrisburg, PA)
- …related experience including quality improvement, HEDIS operations, and Risk Adjustment . Experience with quality rating systems, Medicare products, ... Oversee aspects of the company quality measure improvement outreach strategy including the execution of function for all markets...best practices towards achieving market and product quality and risk goals + Serve as subject matter expert in… more
- Point32Health (Canton, MA)
- …for key initiatives + Serve as the key liaison for Actuarial, Finance, Risk Adjustment , Corporate Data and Analytics, Medical Cost Management, and Pharmacy ... years in Medicare Advantage, Medicaid managed care, or healthcare product strategy . + Preferred: 5 years of experience with D-SNPs or dual-eligible populations.… 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 ... to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Humana (Concord, NH)
- …assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes ... of care and documentation improvements. + Monitor and develops strategy with Coding educator and leader, tailor's provider group...with healthcare providers + Ability to work independently + Medicare Risk Adjustment knowledge +… more
- Molina Healthcare (Iowa City, IA)
- …Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives provider ... place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** +...Healthcare. + 1 year of experience in Medicaid and/or Medicare managed care To all current Molina employees: If… more
- Highmark Health (Pittsburgh, PA)
- …**Quality & Risk Management** : Strategically develop STARS/Quality and Risk Adjustment initiatives across the Government Business segment, driving ... health outcomes, optimizing Stars ratings, and ensuring the accuracy and completeness of risk adjustment data to maximize revenue and resource allocation. +… more
- CenterWell (Indianapolis, IN)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance + Interview, hire, and supervise… 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 ... executive responsible for shaping and executing the region's clinical engagement strategy . This role drives quality improvement, cost efficiency, and population… more
- Point32Health (Canton, MA)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... **Job Summary** The Director of Contracting is responsible for contract strategy , development, negotiation, and implementation for hospitals, physician groups, and… 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...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- East Boston Neighborhood Health Center (Revere, MA)
- …340B program, and Medicaid/ Medicare reimbursement + Third-party billing, risk adjustment , and alternative payment methodologies + Grants management ... state PACE financial requirements, including budgeting, encounter reporting, capitation reconciliation, risk adjustment , and cost allocation. + Serve as internal… more
- Elevance Health (Nashville, TN)
- …hospital medical records to ensure proper ICD-9 coding and compliance with risk adjustment requirements. **Location:** Virtual: This role enables associates to ... for both revenue project and RADV. + Assists with National and Targeted Risk Adjustment Data Validation audits. + Participates and represents the department… more
Related Job Searches:
Adjustment,
Medicare,
Medicare Risk Adjustment,
Risk,
Risk Adjustment,
Strategy