- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- MVP Health Care (Schenectady, NY)
- …audits for Medicare and Commercial programs required + Experience in risk adjustment payment models strongly + Intermediate Microsoft Excel skills, including ... To achieve this, we're looking for a **Professional, Sr. Risk Adjustment Analyst** to join #TeamMVP. This...+ Supporting development and execution of a multi-year improvement strategy and annual plan of action to maximize reimbursement.… more
- Ankura (Lexington, NY)
- …deliver work and seeks to gain additional opportunities for development in a variety of risk adjustment related areas. Qualifications: + Certified in Risk ... at least five (5) recent years of experience in HCC/ Risk Adjustment and/or RADV Audit Methodology +...at critical inflection points related to conflict, crisis, performance, risk , strategy , and transformation. The Ankura team… 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
- Humana (Albany, NY)
- …+ 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
- Molina Healthcare (Syracuse, NY)
- …the integrity of enterprise revenue, and enabling the organization's overall risk adjustment strategy . Knowledge/Skills/Abilities + Responsible for ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy , governance, and oversight… more
- Highmark Health (Albany, NY)
- …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 (Albany, NY)
- …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
- Humana (Albany, NY)
- …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 (Albany, NY)
- …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