- CVS Health (Tallahassee, FL)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- Molina Healthcare (FL)
- …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... Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare /MMP. Assists with research, development, and completion of special… more
- Insight Global (Tampa, FL)
- Job Description Insight Global is hiring HCC/ Risk Adjustment Medical coders to support a backlog for inpatient and outpatient Medicare advantage projects . ... or AHIMA, or a CCS. Will be coding more risk adjustment vs profee. Most of the...and non-HCC codes. These markets are still only reviewing Medicare Advantage members. I would say 20-30% of our… more
- Molina Healthcare (Orlando, FL)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... improvement and coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and modeling and driving… more
- AdventHealth (Altamonte Springs, FL)
- …social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient Identifies ... the patient stay through the monitoring of each patient's readmission risk scores and coordinating readmission mitigation interventions. Consults Social Work for… more
- Humana (Tallahassee, FL)
- …analyze large data sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment , pharmacy knowledge a plus + Certified Coder (CPC, CRC, ... to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align… more
- AdventHealth (Winter Garden, FL)
- …Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient + ... the patient stay through the monitoring of each patient's readmission risk scores and coordinating readmission mitigation interventions. + Consults Social Work… more
- Molina Healthcare (Jacksonville, FL)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job Qualifications** **Required… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... performance improvement and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and modeling and… more