- Baylor Scott & White Health (Columbus, OH)
- …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
- Elevance Health (Cincinnati, OH)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and… more
- Molina Healthcare (Cleveland, OH)
- …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
- CVS Health (Columbus, OH)
- …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
- Deloitte (Cleveland, OH)
- …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 (Cincinnati, OH)
- …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 (Columbus, OH)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining...+ Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development… more
- CVS Health (Columbus, OH)
- …consulting, financial strategic analysis. + Understanding of value-based care, including risk adjustment methodologies (eg, HCC coding), quality measurement ... development of provider performance improvement initiatives + Establish a program management framework for VBC improvement initiatives-- monitoring the impact… more