- Molina Healthcare (Cincinnati, OH)
- …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 (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …team and plays a critical part in forecasting risk scores and revenue for the Medicare Advantage Part D business. The successful candidate will lead efforts to ... FSA or plus relevant advanced degree + Experience with Medicare Part D + Familiarity with Risk Score Data...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- ChenMed (Cincinnati, OH)
- …for multiple payers strongly preferred + Healthcare experience within the Medicare Advantage population preferred. + Medical Assistant certification preferred ... understanding of the company's patient population, including the complexities of Medicare programs + Exceptional organizational skills with the ability to… more
- Humana (Columbus, OH)
- …solutions to improve clinical outcomes and lower costs for millions of Medicare Advantage beneficiaries leveraging data science & analytics, clinical expertise, ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Highmark Health (Columbus, OH)
- …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
- WTW (North Canton, OH)
- …a leading direct-to-consumer insurance services business, specializing in the distribution of Medicare Advantage , Medicare Supplement and Life & Supplemental ... insurance policies. Our focus is on leveraging our highly skilled team of over 3,000 professionals to deliver innovative solutions for our insurance carrier partners and provide consumers with a best-in-class experience. We work with some of America's largest… more
- Molina Healthcare (OH)
- …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
- Trinity Health (Columbus, OH)
- …(https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu) , a Medicare Advantage plan (https://www.medigold.com) , and extensive ... outreach and community wellness programs, Mount Carmel Health System (https://www.mountcarmelhealth.com/) serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years. As a proud member of… more