- NASCO (Austin, TX)
- …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
- Humana (Austin, TX)
- …analyze large data sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment , pharmacy knowledge a plus + Certified Coder (CPC, CRC, ... to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align… more
- Molina Healthcare (Fort Worth, TX)
- …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 (Fort Worth, TX)
- …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
- Centene Corporation (Austin, TX)
- …intelligence and visualization tools including Microsoft PowerBI. Experience in risk adjustment , clinical coding, financial reporting/analysis, or CMS/State ... encounters and regulatory file submissions preferred; Experience with data mining, population health, and statistical modeling preferred. Pay Range: $68,700.00 - $123,700.00 per year Centene offers a comprehensive benefits package including: competitive pay,… more
- Molina Healthcare (Austin, TX)
- …directly with **clinicians, nurses, or case management teams** + Familiarity with risk adjustment , value-based care models, or healthcare performance metrics + ... Understanding of regulatory and compliance considerations (eg, HIPAA) in data handling 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… more
- Deloitte (Fort Worth, TX)
- …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
- Insight Global (Austin, TX)
- …* Multi-state NP licensure across the program's target states. * Knowledge of risk adjustment coding and documentation in a telehealth setting. * Experience ... working in telehealth wellness visit models. * Strong background in preventive care, population health, and quality measure performance null We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic… more
- Datavant (Austin, TX)
- …+ 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
- Molina Healthcare (San Antonio, TX)
- …directly with **clinicians, nurses, or case management teams** + Familiarity with risk adjustment , value-based care models, or healthcare performance metrics + ... Understanding of regulatory and compliance considerations (eg, HIPAA) in data handling 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… more