- Molina Healthcare (Austin, TX)
- …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 (Austin, TX)
- …department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which ... includes implementation of elements of an effective compliance program . Oversee the development of risk assessments...assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to… more
- Humana (Austin, TX)
- …Business, Finance, Health Care/Administration, RN or a related field + Experience with Medicare Risk Adjustment and/or medical coding + Proven organizational ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor… more
- CVS Health (Austin, TX)
- …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 (Austin, TX)
- …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
- Humana (Austin, TX)
- …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
- CenterWell (Fort Worth, TX)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... performance improvement and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and modeling and… more
- CenterWell (Arlington, TX)
- …(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
- Humana (Austin, TX)
- …in Medicare Advantage or Value-Based Care + AAPC CRC (Certified Risk Adjustment ) Certification + AAPC CDEO (Certified Documentation Expert Outpatient) ... + This role is part of Humana's driver safety program and therefore requires an individual to have a...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Austin, TX)
- …with corporate and market teams, including IT, Quality Operations and Compliance, and Risk Adjustment , as well as vended partners. The Senior Data ... expertise and business intelligence in supporting execution of the HEDIS program and related activities, all within tightly regulated requirements and timelines.… more