- Datavant (Sacramento, CA)
- …team coordinates efforts between internal resources and clients in support of custom risk adjustment projects and reports on project status to all stakeholders. ... technology or related field + Knowledge of healthcare industry, payment models, risk adjustment , medical coding, physician workflow, and/or electronic health… more
- Datavant (Sacramento, CA)
- …strategic recommendations to help clients understand the shifts and trends happening in the risk adjustment coding space. **What you will bring to the table:** + ... + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS experience. + Familiarity with HIPAA… more
- Highmark Health (Sacramento, CA)
- …in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS ... to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare… more
- Humana (Irvine, CA)
- …working with physician groups, provider contracting, market operations, and Medicare Risk Adjustment and Stars/Quality functions + Knowledge and Experience ... this team, managing the annual budget, financial planning and projections, risk management and operational reporting while working with value-based providers,… more
- Humana (Sacramento, CA)
- …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
- Stanford Health Care (Palo Alto, CA)
- …education, preferred. + Experience with Vizient, Premier, Elixhauser and other risk adjustment methodologies, highly preferred. **Required Knowledge, Skills and ... and application of CDI practices, coding rules and regulations, and conducts risk assessments of potential and detected compliance deficiencies, as well as… more
- Emanate Health (Covina, CA)
- …in care. Oversee analytics, reporting, and client enablement programs focused on risk adjustment accuracy and quality measure performance (HEDIS, STAR Ratings, ... CAHPS, etc.). **Job Requirements** **Minimum Education Requirement :** **Minimum Experience Requirement :** Ten (10) years of experience in quality HEDIS and P4P. **Minimum License Requirement :** None. Delivering world-class health care one patient at a time.… more
- Deloitte (Los Angeles, CA)
- …product strategy + Reimbursement models - including value-based care/ACO modeling + Risk adjustment mechanisms + Group insurance products including disability, ... long term care, etc. + Mergers and Acquisitions + Health care reform including individual medical and small group markets and/or state Medicaid programs The wage range for this role takes into account the wide range of factors that are considered in making… more
- Scripps Health (San Diego, CA)
- …Categories (HCCs) for accuracy and compliance as relates to Outpatient CDI. Monitors Risk Adjustment Factor (RAF) Scores. * Directs instructions and education ... activities for all Outpatient providers and ancillary staff across the system, in collaboration with, clinic managers, CDI Educators, Physician Advisors, and coding departments, on coding and documentation related issues. Promotes compliance with CMS, third… more
- Datavant (Sacramento, CA)
- …+ Familiarity with healthcare data, with bonus points for experience in the payer risk adjustment space + Deep comfort working with engineering and analytics ... teams to solve ambiguous and complex data challenges + A systems mindset: you enjoy untangling complexity and designing structures that scale + Skilled at taking complex topics and communicating them clearly to both technical and non-technical audiences +… more