- CVS Health (Austin, TX)
- …Integrity team is hiring Senior Coding Data Quality Auditors to support our growing risk adjustment efforts. This role plays a critical part in ensuring coding ... for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in… more
- Datavant (Austin, TX)
- …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
- Molina Healthcare (Fort Worth, TX)
- **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of ... the integrity of enterprise revenue, and enabling the organization's overall risk adjustment strategy. Knowledge/Skills/Abilities + Responsible for encounters… more
- Humana (Austin, TX)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... + Experience in Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining and predictive modeling techniques + Ability… more
- Datavant (Austin, TX)
- …reports directly to the Director of Strategic Operations. As a trusted partner to the Risk Adjustment COO and broader leadership team, you'll play a key role in ... for delivering results **Bonus Points If:** + You have experience in risk adjustment coding applications and technology \#LI-BC1 We are committed to building a… more
- Datavant (Austin, TX)
- …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 (Austin, TX)
- …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
- CenterWell (Fort Worth, TX)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and...care as a team *Ensure clinicians effectively co-manage high risk episodes of care and patients with partnered Care… more
- CenterWell (Arlington, TX)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and...as a team + Ensure clinicians effectively co-manage high risk episodes of care and patients with partnered Care… more
- Highmark Health (Austin, TX)
- …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