- Humana (Albany, NY)
- … and Medicaid Services (CMS). The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures ... Qualifications** + Master's Degree + HEDIS Diabetes Eye Exam measure + Medicare Stars experience **Additional Information** As part of our hiring process for… more
- Humana (Albany, NY)
- … and Medicaid Services (CMS). The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures ... insights **Preferred Qualifications** + Master's Degree + HEDIS experience/knowledge + Medicare Stars experience **Additional Information** As part of our hiring… more
- Molina Healthcare (Syracuse, NY)
- …and oversight of processes that track, evaluate, and submit encounter deletions for Medicare Advantage , ACA, and Medicaid lines of business. This role has ... in Director level role or above. + Extensive understanding of Medicare Advantage , ACA and Medicaid risk adjustment processes, including encounter data submission… more
- Datavant (Albany, NY)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage , HHS (ACA), and other markets. + Provide guidance and make ... inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- NASCO (Albany, NY)
- …laws and regulations related to our products and services, including for our Medicare Advantage and ACA Exchanges business + Interacts with vendors and ... counsel on compliance issues, including related to HIPAA + Experience supporting Medicare Advantage and ACA Exchanges business **Required Training, Certification… more
- Centers Plan for Healthy Living (Bronx, NY)
- …working weekends and requires frequent travel to various Centers Plans or Healthy Living Advantage Care Medicare HMO Plan sites located throughout the five (5) ... boroughs. Territory Management + Maintain Centers Plans for Healthy Living Advantage Care Medicare HMO Plan visibility in the community by monitoring multiple… more
- Highmark Health (Albany, NY)
- …gain share and risk share models and will be implemented for the Organization's Medicare Advantage , Medicaid, ACA, and commercial populations with the goal of ... interpretation, and outcomes strategic plan development. + 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health… more
- Molina Healthcare (NY)
- …proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the ... Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing… more
- MVP Health Care (Tarrytown, NY)
- …Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), HARP, Off-Exchange, Medicare Advantage (MA) products, and Dual Eligible Special Needs Plans ... (D-SNP). + **Conduct both individual and group outreach activities** to present our innovative health care solutions on- and off-site at various events-from health fairs and community expos to festivals and holiday-themed gatherings-ensuring MVP's presence is… more
- MVP Health Care (Whitehall, NY)
- …Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), HARP, Off-Exchange, Medicare Advantage (MA) products, and Dual Eligible Special Needs Plans ... (D-SNP). + Conduct both individual and group outreach activities to present our innovative health care solutions on- and off-site at various events-from health fairs and community expos to festivals and holiday-themed gatherings-ensuring MVP's presence is both… more