- Baylor Scott & White Health (Lansing, MI)
- …internal and external sources to provide insight to decision-makers. This role supports program management activities around risk adjustment data management ... + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible...such as revenue forecasting and ROI. + Contributes to program improvement by designing and implementing business process and… more
- Humana (Lansing, MI)
- …business outcomes. + Lead financial analytics projects, with a focus on outcomes of Medicare risk adjustment operations and initiatives. + Work independently ... actionable insights for non-technical stakeholders. **Preferred Qualifications** + Experience with Medicare Risk Adjustment programs and/or CMS datasets.… more
- Deloitte (Detroit, MI)
- …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider...individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or … more
- Molina Healthcare (Ann Arbor, MI)
- …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
- Molina Healthcare (Detroit, MI)
- …with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/ Risk , Director of ... revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge… more
- Henry Ford Health System (Troy, MI)
- …billing and third-party payer regulations. + Knowledge of CMS programs, processes, risk adjustment payment methodology, and payment principles. + Knowledge of ... deletions of codes, use of modifiers, and revenue codes to be compliant with Medicare rules and regulations, the Medicare Billing Manual, the American Medical… more
- Molina Healthcare (Detroit, MI)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... in line with industry standards and best practices * Assists with new program implementation and supports the health plan in-source BH services * Additional duties… more
- Humana (Lansing, MI)
- …Qualifications** + Bachelors Degree + Knowledge and/or experience within the Stars Organization, Risk Adjustment and/or Provider + PMP or CAPM Certification + ... include but not limited to Intake, Charter, Governance Structure, Project Plan, Risk /Issues Tracking, etc. + Analyze project portfolio to ensure project updates,… more