- Molina Healthcare (NY)
- …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
- Excellus BlueCross BlueShield (Rochester, NY)
- …right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making ... coding policies to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following… more
- Healthfirst (NY)
- …from an accredited institution. + At least 5 years previous work experience within risk adjustment + Credentialed Associate of the Society of Actuaries (ASA) + ... supporting Product and Actuarial analytical requests. + Experience with CMS/HHS risk adjustment payment methodologies. + Self-motivated, creative problem solver… more
- Independent Health (Buffalo, NY)
- …on pricing outcomes. + Establish and implement claims review processes to support risk adjustment . Analyze data and provide strategic insights to enhance pricing ... and financial performance. + Ensure compliance with CMS regulations and risk adjustment methodologies. + Develop and execute pricing strategies, incorporating… more
- New York State Civil Service (Bedford Hills, NY)
- …Zip Code 10507 Duties Description Associate Psychologist functions as an advanced clinician and provide professional psychological services under the clinical ... substance and/or chemical abuse programs, specialized assessment (functional, personality, risk , competency, vocational, education); design and application of behavioral… more
- Datavant (Albany, NY)
- …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
- Humana (Albany, NY)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining...use data to drive business outcomes and decisions + Advanced Degree in a quantitative discipline, such as Mathematics,… more
- New York State Civil Service (New York, NY)
- …living including:* Conducting the substance abuse assessments to determine the risk for substance use and harmful behaviors* Identifying treatment services ... Credentialed Alcoholism and Substance Abuse Counselor (CASAC), CASAC Level 2, CASAC- Advanced Counselor, or CASAC Master Counselor in New York State.Addiction… more