- Molina Healthcare (Syracuse, NY)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment...+ Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. +… more
- Molina Healthcare (NY)
- …Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis ... 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …data validation review. Prepares and submits adjustments to the appropriate processing / adjustment area ( Risk Adjustment / Actuarial Services). * Performs ... right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making… more
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
- Healthfirst (NY)
- …Product and Actuarial analytical requests. + Experience with CMS/HHS risk adjustment payment methodologies. + Self-motivated, creative problem solver who ... **Duties:** + Develop and maintain risk score forecasting models to assist Actuarial...+ At least 5 years previous work experience within risk adjustment + Credentialed Associate of the… more
- Molina Healthcare (Syracuse, NY)
- …+ 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
- Humana (Albany, NY)
- …a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. In this position, the Senior Research Scientist ... advanced statistical methods to rigorously evaluate the impact of risk adjustment programs and pilot projects. The...will collaborate with colleagues specializing in data science and actuarial analytics. We are seeking a candidate who brings… more
- Humana (Albany, NY)
- …a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. In this position, the Research Scientist 2 will ... advanced statistical methods to rigorously evaluate the impact of risk adjustment programs and pilot projects. The...will collaborate with colleagues specializing in data science and actuarial analytics. We are seeking a candidate who brings… more