- Elevance Health (Middletown, NY)
- ** 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 (Latham, NY)
- ** 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
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Risk Adjustment Auditor Educator** -St. Peter's Health Partners - Full-time - Remote ... **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Trinity Health (Syracuse, NY)
- …to conduct Education if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding ... and documentation in alignment with risk adjustment models, conducting audits with analysis...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Molina Healthcare (Syracuse, NY)
- …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 (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
- CVS Health (Albany, NY)
- …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
- Molina Healthcare (Syracuse, NY)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures ... providers in the Health Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve… more
- CenterWell (Albany, NY)
- …+ Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record of ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- New York State Civil Service (Bronx, NY)
- …NY Zip Code 10461 Duties Description NYCCC is recruiting a Director of Clinical Risk Management Department to oversee their Risk Management Department and will ... with senior administrators as needed.* Acting as a resource to team leaders/ program directors as well as CRMs, identifying reportable incidents and facilitating the… more
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