- Datavant (Atlanta, GA)
- …The individual will provide superior quality by performing audits pertaining to risk adjustment coding efforts. The individual will be responsible for ... ensuring coding compliance and accuracy + Monitor the performance of the Risk Adjustment Operations both internally and with coding vendors + Provides expertise… more
- Wolters Kluwer (Atlanta, GA)
- …| Wolters Kluwer (https://www.wolterskluwer.com/en/solutions/health-language)** **Coder Workbench Solution:** ** Risk Adjustment Software | Health Language ... the Eastern or Central time zone, have a solid understanding of risk adjustment in the Healthcare Technology space, experience with Payer, Provider, and Vendor,… more
- Molina Healthcare (Columbus, GA)
- …with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/ Risk , Director of ... revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of… more
- Humana (Atlanta, GA)
- …provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes data and ... Coder (CRC) + Experience interacting with healthcare providers + Medicare Risk Adjustment knowledge + Analyzing data to build unique education strategies in… more
- Elevance Health (Atlanta, GA)
- …hospital medical records to ensure proper ICD-9 coding and compliance with risk adjustment requirements. **Location:** Virtual: This role enables associates to ... both revenue project and RADV. + Assists with National and Targeted Risk Adjustment Data Validation audits. + Participates and represents the department in… more
- Humana (Atlanta, GA)
- …+ Lead financial analytics projects, with a focus on outcomes of Medicare risk adjustment operations and initiatives. + Work independently to analyze historical ... insights for non-technical stakeholders. **Preferred Qualifications** + Experience with Medicare Risk Adjustment programs and/or CMS datasets. + Familiarity with… more
- Deloitte (Atlanta, GA)
- …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, DSH, UPL,… more
- Elevance Health (Atlanta, GA)
- …for: + Medical Cost Management (claims review, payment integrity, utilization management, risk adjustment ). + Cost of Care Optimization (clinical analytics, care ... to medical cost optimization. + Strong knowledge of value-based care models, risk -based contracting, and payment integrity. + Executive presence with the ability to… more
- Centene Corporation (Atlanta, GA)
- …market associates with the knowledge and tools to improve Medical Expense Ratio, Risk Adjustment accuracy, and overall financial outcomes. + **Guide Effective ... plans and enterprise Provider Experience team to monitor provider performance of risk arrangements for multiple product lines. + Assist in driving development of… more
- Molina Healthcare (Atlanta, GA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... (APC's), and other payment mechanisms. * Understanding of value-based risk arrangements + Experience in quantifying, measuring, and analyzing financial,… more