- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to blue. Position Summary: This role will provide analytical support to the Risk Adjustment Operations team. We're seeking a detail-oriented, curious, and ... synthesize data; develop analyses and reporting to guide the Medicare strategy . + Assist in creation and...throughout program cycles. + Manage data requirements for different Risk Adjustment activities such as in-home health… more
- Humana (Boston, MA)
- …+ Utilize mathematics, statistics, and programming to generate predictions that drive risk adjustment operations and strategy + Partner with ... advancing predictive modeling and analytics in support of our Medicare and Medicaid business. The HQRI team plays a...within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. The Senior Data Scientist… more
- Highmark Health (Boston, MA)
- …in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS ... central role in the development and execution of the strategy for a given initiative for transformation of workflows...outcomes strategic plan development. + 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value… more
- Datavant (Boston, MA)
- …outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS ... up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …delivery of high-quality, trustable clinical data to support key initiatives around quality, risk adjustment , medicare stars, and interoperability. This is a ... + Collaborate with cross-functional teams, including clinical operations, performance measurement, and risk adjustment , to execute on data procurement & usage… more
- Humana (Boston, MA)
- …analyze large data sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment , pharmacy knowledge a plus + Certified Coder (CPC, CRC, ... to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align… more
- Humana (Boston, MA)
- …Electronic Medical Records, and/or Electronic Notifications. + Familiarity with CMS Risk Adjustment and Quality Measure Reporting. + Experience in ... for development team members based on Humana's LPM (Lean Portfolio Management) strategy with a top-down value approach. + Manage technical relationships with… more
- Bristol Myers Squibb (Worcester, MA)
- …sales goals, maximize promotional budgets, and execute the national sales and brand strategy in accordance with BMS polices + Interpret and integrate data to develop ... laws. + Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geography. + Immunology...by your state of residence; and 3) a driving risk level deemed acceptable by the Company. **Why You… more