- Humana (Syracuse, NY)
- …and help us put health first** The Medical Records Retrieval Representative ( Risk Adjustment Representative 2) travels to provider offices within Upstate/Central ... Madison, Monroe, Oneida, Onondaga, Oswego, St. Lawrence Medical Records Retrieval Representative ( Risk Adjustment Representative 2) + Travels up to 100% in… more
- Albany Medical Center (Albany, NY)
- …and training to providers and coding staff. Act as an expert for the HCC/ Risk adjustment coding. This position is remote but does require onsite education ... for Coding and Reporting. Code chronic disease that meets HCC and Risk Adjustment criteria. Validate missed coding opportunities. + Conducts professional… more
- Molina Healthcare (Buffalo, NY)
- …Excellence. The position acts as a strategic partner with Network, Medical Economics, Risk Adjustment and Quality, Finance, EIM/IT, and Clinical leadership to ... (data), Actuarial (review / validation), Finance (review / validation), Risk Adjustment , and Quality. + Implement and execute the defined enterprise-wide… more
- Datavant (Albany, NY)
- …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
- Centene Corporation (Queens, NY)
- …opportunities. + Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking ... health, improve quality outcomes, and achieve financial sustainability under CMS-aligned risk -based models. This position will be responsible for working with the… more
- SMBC (New York, NY)
- …senior management presentations and regulatory reporting + Support the enhancement and adjustment of credit risk data governance, maintain clear communication ... guide the credit data enhancement initiatives + Collaborate with Risk Management Stress Testing and Scenario Design Team to...risks + Perform daily, weekly, monthly, and ad-hoc credit risk analyses, and communicate key findings to team leadership… more
- Zurich NA (New York, NY)
- …recommendations for quarterly financial results including IFRS 17 components of discount and risk adjustment . + Assist in the preparation of materials for ... global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider… more
- NASCO (Albany, NY)
- …deployment of AI/ML (Machine Learning) and agentic models for payer analytics, risk adjustment , fraud detection, and personalized member engagement + ... deliver data-driven SaaS solutions that enhance healthcare payer operations, risk management, and member engagement. **Responsibilities** Governance + Manages… more
- Molina Healthcare (Albany, NY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... evidence-based guidelines. + Experience in Utilization/Quality Program management + HMO/Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Primary Care preferred). **PHYSICAL DEMANDS:** Working environment is… more
- Molina Healthcare (Yonkers, NY)
- …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