- Highmark Health (Blue Bell, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Development and Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs… more
- Humana (Harrisburg, PA)
- …**Preferred skills** + FSA or plus relevant advanced degree + Experience with Medicare Part D + Familiarity with Risk Score Data + Python **Additional ... MRA Finance team and plays a critical part in forecasting risk scores and revenue for the Medicare Advantage Part D business. The successful candidate will lead… more
- Humana (Harrisburg, PA)
- …a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. In this position, the Senior Research Scientist ... will apply advanced statistical methods to rigorously evaluate the impact of risk adjustment programs and pilot projects. The findings generated will be… more
- Humana (Harrisburg, PA)
- …plays a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. The Senior Data Scientist in this role will ... technology to transform high volumes of complex data into advanced analytic solutions. The Senior Data Scientist work assignments...empower risk adjustment decision makers through predictive analytics.… more
- Humana (Harrisburg, PA)
- …a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. In this position, the Research Scientist 2 will ... partner with a senior research scientist to apply advanced statistical methods to rigorously evaluate the impact of... statistical methods to rigorously evaluate the impact of risk adjustment programs and pilot projects. The… more
- Datavant (Harrisburg, PA)
- …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
- St. Luke's University Health Network (Stroudsburg, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- St. Luke's University Health Network (Allentown, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. . Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. . Monitors risk assessment using available tools and implements discharge interventions… more