- Datavant (Tallahassee, FL)
- …and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of health insurance plans operations + Deep… more
- CenterWell (Tallahassee, FL)
- …clinical documentation. + Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, ... provider coding improvement opportunities, risk score trending and tracking. + Partners with MRA...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions.… more
- Humana (Tallahassee, FL)
- …a focus on learning strategies and adult learning theories + Working knowledge of Medicare Risk Adjustment and/or Stars + Experience using Articulate ... community and help us put health first** Certified Medical Coding Instructor (CPC-I): This is a Senior Learning Design...Information This role will be responsible for supporting the Medicare Risk Adjustment Team within… more
- AdventHealth (Tampa, FL)
- …and approved coding policies and procedures. . Participates in the mortality/ risk adjustment reviews when assigned. . Assists with post-payment DRG appeals. ... a Primary Stroke Center. **The ro** **le you'll contribute:** The Inpatient Coding Quality Auditor, under general supervision of the Inpatient Operations Manager, is… more
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... also oversee the improvement of clinical documentation accuracy for Medicare and Exchange members. While under the direction of...in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving… more
- Bristol Myers Squibb (Tampa, FL)
- …complex, high cost buy and bill therapy reimbursement experience including: + Coverage, coding , billing and payment + Medicare (NCD, IPPS, OPPS, 340B, etc.) ... Government payer policy, local payer dynamics and coverage policy, complex reimbursement, coding & billing dynamics, and all components of the Cell Therapy ordering… more
- Molina Healthcare (St. Petersburg, FL)
- …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
- Molina Healthcare (FL)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), + Diagnosis Related Groups ... lead to value + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job...and other payment mechanisms. * + Understanding of value-based risk arrangements + Experience in quantifying, measuring, and analyzing… more
- Humana (Pompano Beach, FL)
- …records are reviewed by Humana's Coding staff. The Medical Record Retrieval Representative ( Risk Adjustment Representative 2): + Travel up to 50% of the time ... community and help us put health first** The Medical Record Retrieval Specialist ( Risk Adjustment Representative 2) travels to provider offices within the region… more
- CenterWell (Tallahassee, FL)
- …rehab + Previous experience working in/with the primary care setting + Risk adjustment experience + Auditing experience + Coding background + Ability to work ... knowledge + Health Plan experience working with large carriers + Previous Medicare /Medicaid experience a plus + Previous experience in chronic disease management,… more