- Humana (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …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
- Highmark Health (Richmond, VA)
- …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
- Humana (Richmond, VA)
- …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
- Humana (Richmond, VA)
- …community and help us put health first** The Medical Records Retrieval Specialist/ Risk Adjustment Representative 2 will contact and schedule with provider ... offices to return medical records timely. This role includes remote access retrieval from larger provider groups as well as administrative retrieval tasks. Virginia The Medical Records Retrieval Specialist ensures accurate and properly supported clinical… more
- Deloitte (Richmond, VA)
- …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
- Datavant (Richmond, VA)
- …+ 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
- Evolent (Richmond, VA)
- …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