- 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
- Highmark Health (Albany, NY)
- …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
- Excellus BlueCross BlueShield (Rochester, NY)
- …health plan in response to regulatory changes. + Assists in the preparation of risk adjustment analyses. + Supports risk sharing analyses, capitation ... development, and associated settlements. + Assists in performing analyses used in the development of financial planning, forecasting and other financial projections. + Prepares and/or maintains appropriate documentation of work. + Completes and/or supports… more
- Molina Healthcare (Syracuse, 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
- WelbeHealth (Albany, NY)
- …education and experience in coding and auditing + Minimum of two (2) years of Risk Adjustment (HCC) coding experience in a managed care environment + Current ... and participate in provider education programs to ensure compliance with CMS risk adjustments diagnosis coding guidelines + Work closely with Coding Supervisor in… more
- Molina Healthcare (Yonkers, NY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... evidence-based guidelines. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an… more
- WMCHealth (Valhalla, NY)
- …Applicant link Job Details: Job Summary: Serves as an internal expert on Risk Adjustment and Hierarchical Conditions Categories (HCC) coding. Specific duties ... setting with one or more of the following credentials: Certified Risk Coder (CRC), Certified Professional Coder certification (CPC), Certified Professional Medical… more
- Molina Healthcare (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
- Molina Healthcare (Buffalo, 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
- CVS Health (Albany, NY)
- …consulting, financial strategic analysis. + Understanding of value-based care, including risk adjustment methodologies (eg, HCC coding), quality measurement ... frameworks, and payer-provider collaboration. + Strong analytical skills, with the ability to translate complex data into actionable reporting and insights. + Excellent communication and collaboration skills, demonstrated relationship management skills at the… more