- Molina Healthcare (WA)
- **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
- Molina Healthcare (Tacoma, WA)
- …well as automated analytical as well as Reporting modules related to Risk Adjustment for Medicaid, Marketplace and Medicare /MMP. + Assist Risk ... **Job Description** **Job Summary** The Analyst, Risk Adjustment -Predictive Analytics role will support Molina's Risk Adjustment Predictive Analytics… more
- Datavant (Olympia, WA)
- …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, WA)
- …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
- Datavant (Olympia, WA)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and ... execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development of robust, scalable, and actionable analytics… more
- Molina Healthcare (Spokane, WA)
- …**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 (WA)
- …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
- Molina Healthcare (WA)
- …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
- Humana (Olympia, WA)
- …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
- Molina Healthcare (Bellevue, WA)
- …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
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