- Molina Healthcare (Kearney, NE)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. + Analyze… more
- Datavant (Lincoln, NE)
- …outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS ... up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Molina Healthcare (Bellevue, NE)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Molina Healthcare (Grand Island, NE)
- …**Knowledge/Skills/Abilities** * Assist in the daily operations of all aspects of risk adjustment data validation related activities, including, but not limited ... retrieval, file transmissions, and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, milestones… more
- Molina Healthcare (Grand Island, NE)
- …**Job Summary** The Junior Analyst will play a supporting role on the RADV ( Risk Adjustment Data Validation) team, assisting in the execution of CMS and ... and confirm required data elements. + Collaborate with internal teams-including IT, Risk Adjustment operations, and clinical teams-to ensure accurate and… more
- Datavant (Lincoln, NE)
- …and life experiences to realize our bold vision for healthcare. As an Auditor, HCC Risk Adjustment Coder, you will review medical records to identify and code ... using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical… more
- CVS Health (Lincoln, NE)
- …codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. + ... Senior Coding Data Quality Auditors to support our growing risk adjustment efforts. This role plays a...ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of… more
- Molina Healthcare (Lincoln, NE)
- …+ Extensive understanding of Medicare Advantage, ACA and Medicaid risk adjustment processes, including encounter data submission and deletion requirements ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for...processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This… more
- Molina Healthcare (Grand Island, NE)
- …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
- Highmark Health (Lincoln, NE)
- …in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS ... interpretation, and outcomes strategic plan development. + 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population… more
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