- Humana (Albany, NY)
- …closely with internal stakeholders including Finance, Actuarial, Clinical, Medicare Risk Adjustment , Provider Contracting, and Provider Engagement internally ... + Leverages data analytics, business insights, cross-functional collaboration, in-depth business knowledge, and strong written and verbal communication skills to drive optimization of financial and operational performance for the region + Leads membership,… more
- CVS Health (Albany, NY)
- …metrics** , and **provider performance** + Familiarity with **claims data** , ** risk adjustment ** , or **value-based care models** + **Advanced Analytics:** ... + Experience with **machine learning** techniques and model evaluation + Exposure to **generative AI** or **LLMs** for enhancing analytics and automation **Software & Tools:** + Experience with **version control** (eg, Git) + Familiarity with **BigQuery,**… more
- MVP Health Care (Schenectady, NY)
- …with provider offices and facilities to obtain medical records for the purpose of the Risk Adjustment team validating diagnoses that were sent to CMS (Center for ... Medicare & Medicaid Services). + Works to collect medical records under a sometimes very strict deadline. + Contacts local provider offices to schedule appointments to obtain medical records using a laptop and mobile scanner within the provider office. + Makes… more
- Molina Healthcare (Albany, NY)
- …applications -_** **which underpin essential business functions such as HEDIS reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure ... Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you are interested in applying for this position, please apply through the… more
- St. Mary's Healthcare (Amsterdam, NY)
- …preferred. Demonstrated knowledge of ICD-10-CM/PCS, CPT/HCPCS coding, MS-DRGs, APR-DRGs, APCs, and risk adjustment . Certifications / Licensure: + RHIA, RHIT, or ... CCS credential required. Required Skills and Attributes: + Proven leadership, communication, and change management skills. + Ability to analyze data, generate actionable insights, and present to senior leadership. + Must be able to multitask while remaining… more
- Evolent (Albany, NY)
- …decision support systems is preferred + **Background in value-based care** models, risk adjustment , and quality measurement programs is preferred + **Experience ... with healthcare analytics** and population health management platforms is preferred **Healthcare Domain Knowledge That Matters** + Deep understanding of clinical workflows, value-based care models, and healthcare economics + Knowledge of healthcare regulatory… more
- Datavant (Albany, NY)
- …+ 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
- Deloitte (Rochester, NY)
- …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
- New York State Civil Service (New York, NY)
- …Agency Financial Services, Department of Title Financial Services Specialist 4 ( Risk ), SG-27 Occupational Category Financial, Accounting, Auditing Salary Grade 27 ... Services is seeking candidates for the position of Financial Services Specialist 4 ( Risk ) within the Property Bureau. Duties include, but are not limited to, the… more
- Citigroup (Queens, NY)
- …of the Fundamental Review of the Trading Book (FRTB) and Credit Valuation Adjustment (CVA) RWA Forecasting frameworks under Basel IV. The role bridges Risk ... translating regulations into deliverables, and coordinating across multiple functions (Market Risk , Credit Risk , Treasury, Finance, Quantitative Modeling, and… more