• Senior Data Scientist

    Humana (Madison, WI)
    …+ 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
    Humana (09/06/25)
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  • AVP, Encounters

    Molina Healthcare (Kenosha, WI)
    …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
    Molina Healthcare (08/22/25)
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  • Value-Based Reimbursement Specialist

    Highmark Health (Madison, WI)
    …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
    Highmark Health (08/20/25)
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  • Regional VP, Health Services Central Region

    Humana (Madison, WI)
    …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, Health Services requires an in-depth… more
    Humana (08/01/25)
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  • Senior Client Coding Project Manager

    Datavant (Madison, WI)
    …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
    Datavant (06/28/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Madison, WI)
    …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 (08/23/25)
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