- BlueCross BlueShield of North Carolina (NC)
- …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + ... The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous health and… more
- Baylor Scott & White Health (Raleigh, NC)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... to provide insight to decision-makers. This role supports program management activities around risk adjustment data management and submissions to CMS. This role… more
- Humana (Beaufort, NC)
- …exceptional follow up skills + Valid Driver's license and reliable transportation + Medicare Risk Adjustment knowledge **Additional Information** Work at ... leadership, webinars public speaking and/or presentation skills with healthcare providers + Risk Adjustment knowledge + Familiar with coding guidelines + Live… more
- Humana (Raleigh, NC)
- …business outcomes. + Lead financial analytics projects, with a focus on outcomes of Medicare risk adjustment operations and initiatives. + Work independently ... actionable insights for non-technical stakeholders. **Preferred Qualifications** + Experience with Medicare Risk Adjustment programs and/or CMS datasets.… more
- Humana (Raleigh, NC)
- …Finance, Health Care/Administration, RN or a related field + Experience with Medicare Risk Adjustment + Progressive experience with interoperability ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies + Recommends execution strategies and monitor… more
- Datavant (Raleigh, NC)
- …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 (Raleigh, NC)
- …Programs experience including Medicare ,** **Commercial ACA, and/or Medicaid** + ** Risk adjustment working knowledge and understanding** + **Understanding of ... maintaining robust data pipelines that power reporting and analytics for risk adjustment and provider performance projects. You'll work closely with analysts,… more
- Deloitte (Raleigh, NC)
- …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider...individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or … more
- Deloitte (Raleigh, NC)
- …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 (Raleigh, NC)
- …Qualifications** + Bachelors Degree + Knowledge and/or experience within the Stars Organization, Risk Adjustment and/or Provider + PMP or CAPM Certification + ... include but not limited to Intake, Charter, Governance Structure, Project Plan, Risk /Issues Tracking, etc. + Analyze project portfolio to ensure project updates,… more
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