- Elevance Health (Tampa, FL)
- ** Medicare Risk Adjustment Advanced Analytics Analyst** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...Performs data mining and data-driven analyses to evaluate historical program performance and to inform current operating decisions. +… more
- Elevance Health (Tampa, FL)
- ** Medicare Risk Adjustment Advanced...and internal partners to apply the insights to drive risk adjustment program innovation and ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...the right members for the right service, to measure program outcomes, and to support information-based strategic decision making.… more
- Molina Healthcare (St. Petersburg, FL)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Centene Corporation (Tallahassee, FL)
- …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare ...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- CVS Health (Tallahassee, FL)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- CVS Health (Tallahassee, FL)
- …and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. + ... Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work...Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories… more
- CVS Health (Tallahassee, FL)
- …codes. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred. ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
- Molina Healthcare (FL)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality… more
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... improvement and coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and modeling and driving… more
- AdventHealth (Winter Garden, FL)
- …out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program *For eligible positions* + Whole Person Well-being and Mental Health ... Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient +… more