- Ankura (Los Angeles, CA)
- …assessment. + Apply innovative techniques to healthcare engagements including those related to Risk Adjustment . + Expand and build new products in a ... an Industry thought leader in healthcare topics like predictive analytic applications, risk adjustment , and value-based care. + Develop, supervise, and motivate… more
- Deloitte (Los Angeles, CA)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- Humana (Sacramento, CA)
- …of experience in root cause analysis, inner working of provider office and systems, or risk adjustment . + Proven ability to compare, read, and report on claims ... related field. + Python, SQL, Databricks, or Power BI experience. + Risk adjustment background or knowledge. + Experience in provider office environments and… more
- UCLA Health (Los Angeles, CA)
- …and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk -based audits, ... contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide...audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with stakeholders and leadership to… more
- Sutter Health (Sacramento, CA)
- …finance foundation and solid understanding of provider reimbursement principles-such as risk adjustment , capitation, and fee-for-service-who can apply this ... with Operations and MCF.** + **Validate CMS Medicare Advantage and ACA risk scores, along with payer codes, for accuracy, consistency, and compliance.** +… more
- Vatica Health (CA)
- …This unique combination of people, process, and technology unites Vatica's #1-rated risk adjustment platform with Cozeva's #1-rated quality and population health ... customers and guide them through a seamless onboarding process, reducing churn risk and establishing a foundation for a long-term partnership. The Enterprise… more
- Humana (Sacramento, CA)
- …**Preferred Qualifications** + Bachelor's degree in business administration/information systems + Medicare Risk Adjustment background and knowledge. + 1 or more ... years of experience in SQL, databricks, or Power BI + Experience in designing, developing, and maintaining visually appealing reports and dashboards in Power Bi, Microsoft PowerPoint, or similar applications. + Automation experience. + Proficiency in… more
- Providence (CA)
- …the rate development and filing efforts including competitive analysis, network analysis, risk adjustment , trend, actuarial value analysis, rate adequacy review, ... etc. Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your… more
- reveleer (CA)
- …a technology-enabled healthcare services company that delivers performance measurement, quality, and risk adjustment solutions to health plans and Managed Care ... Organizations nationwide. We partner with healthcare providers to retrieve critical medical record data and deliver accurate, auditable results that support revenue integrity and improved quality of care. Position Overview Reveleer is seeking a Senior Staff… more
- Dignity Health (Bakersfield, CA)
- …and dual eligible populations, and benefit systems is preferred. - HEDIS/Stars and HCC/ Risk adjustment knowledge. \#LI-DH **Where You'll Work** The purpose of ... Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage… more