- UCLA Health (Los Angeles, CA)
- …The NCQA and CMS Star Rating Program Manager will lead initiatives to drive the Medicare Advantage Plan's success in NCQA Health Plan Accreditation and CMS Star ... of NCQA survey process and IRT systems + Knowledge of Medicare Advantage operations, CMS regulations, and health services program requirements + Knowledge… more
- UCLA Health (Los Angeles, CA)
- Description As a member of the Medicare Advantage Operations team, Business Data Analyst is instrumental in independently developing the detailed requirements ... + Minimum of five (5) years' experience in a Medicare or Managed Care environment managing enrollment, claims or...five (5) years' experience with CMS processes in a Medicare or Managed Care environment required + Experience with… more
- Highmark Health (Sacramento, CA)
- …Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including ... (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment… more
- Sutter Health (Sacramento, CA)
- …Monitors and reports on the performance of each business line, including Medicare Advantage and preferred provider organization health care plans. Participates ... as well as an advanced understanding of key government programs (( Medicare /Medicaid) and market segments (individual, small group, etc.). + In-depth knowledge… more
- Elevance Health (Los Angeles, CA)
- …an accommodation is granted as required by law. The **Actuarial Analyst III** supports Medicare Advantage pricing and bid development within the Medicare ... Actuarial team. **How You Will Make an Impact:** Primary duties may include, but are not limited to: + Benefit Ownership: Manage assigned pricing models and benefits, ensuring data accuracy, methodology consistency, and timely bid filing readiness. + Contract… more
- Humana (Sacramento, CA)
- …+ **Industry Knowledge** : Familiarity with the healthcare sector, specifically Medicare Advantage , and an understanding of regulatory frameworks and ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- …+ Strong understanding of different insurance products such as HMO, PPO, and Medicare Advantage plans. + Strong organizational skills with ability to prioritize ... projects, work relatively independently, manage multiple tasks, and meet deadlines. + Comfortable talking to patients about their estimated balances and explaining benefits. + Sensitivity to and willingness to interact with persons of various social, cultural,… more
- Datavant (Sacramento, CA)
- …teams to improve productivity and quality.** + Run various risk adjustment models for Medicare Advantage , Medicaid or ACA to forecast patient risk scores and ... return on investment based on historical data and project variables + Work closely with cross-functional teams, including clients, to understand business needs, and determine the right methodology for analysis and assumptions to provide data-driven insights… more
- Providence (Irvine, CA)
- …matters, including interpretation, negotiation, and dispute resolution related to commercial, Medicare Advantage , and Medicaid managed care agreements. + Advise ... on reimbursement methodologies, payment terms, audit rights, dispute resolution provisions, limitations of liability, and risk allocation in payor agreements. + Partner with Revenue Cycle and Finance teams to support payor strategy and escalation of contract… more
- Dignity Health (Bakersfield, CA)
- …audit tools, denial management, and provider relations workflows + Knowledge of Medicare Advantage , Commercial, and Medi-Cal managed care recovery requirements. ... **Where You'll Work** The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business… more