- Deloitte (Tampa, FL)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- Humana (Alachua, FL)
- …community and help us put health first** The Medical Record Retrieval Specialist ( Risk Adjustment Representative 3) Travels to provider offices within the region ... The records are reviewed by Humana's Coding staff. The Medical Record Retrieval Representative ( Risk Adjustment Representative 3): + Travel up to 60% of the time… more
- Molina Healthcare (Tampa, 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
- Molina Healthcare (Miami, FL)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... State (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …cross-functional teams. + Strong understanding of the healthcare payer landscape, with Risk Adjustment experience highly preferred. + Proven experience in ... Solutions Convey Health Solutions (Convey) is the trusted partner for Medicare payers seeking to streamline operations, optimize performance, and elevate member… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment , Stars performance, and member engagement. Pareto's deep ... or analytics platforms preferred. + Familiarity with RFP tracking systems, Medicare Advantage, or value-based care models is highly desirable. Knowledge, Skills,… 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
- Convey Health Solutions (Fort Lauderdale, FL)
- …solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment , Stars performance, and member engagement. Pareto's deep ... and proactively develop effective and practical legal strategies and solutions to address risk + Create processes for and manage compliance with securities rules and… more
- Molina Healthcare (FL)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work… more
- CVS Health (Tallahassee, FL)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management. * Actively participate ... oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and objectives for… more