- Elevance Health (Columbus, OH)
- ** Risk Adjustment Actuarial Analyst II - Advanced Analytics** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days ... for employment, unless an accommodation is granted as required by law._ The ** Risk Adjustment Actuarial Analyst II - Advanced Analytics** is responsible for… more
- Molina Healthcare (Cincinnati, OH)
- …Summary** The Junior Analyst will play a supporting role on the RADV ( Risk Adjustment Data Validation) team, assisting in the execution of CMS and internal ... and confirm required data elements. + Collaborate with internal teams-including IT, Risk Adjustment operations, and clinical teams-to ensure accurate and… more
- Molina Healthcare (Columbus, OH)
- …Summary** The Senior Analyst will serve a key role on the RADV ( Risk Adjustment Data Validation) team, contributing to the end-to-end data strategy and ... required for audit response. + Collaborate with internal stakeholders-including IT, Risk Adjustment operations, clinical teams, and retrieval vendors-to ensure… more
- Molina Healthcare (Cincinnati, OH)
- …DESCRIPTION** **Job Summary** Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk ... identify risks. Additional leadership opportunities are available to lead national risk adjustment studies. Prior experience in Medicaid risk adjustment… more
- Molina Healthcare (OH)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. + Analyze… more
- Molina Healthcare (OH)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...support for finance, pricing and actuarial functions + Healthcare Analyst I or Financial/Accounting Analyst I experience… more
- Molina Healthcare (Columbus, OH)
- …Summary** This Sr. Analyst , Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing ... queries within project management tools like Azure DevOps. + Risk Adjustment experience and some familiarity with...support for finance, pricing and actuarial functions. + Healthcare Analyst I experience desired. + PowerBI, Excel, Power Pivot,… more
- CVS Health (Columbus, OH)
- …the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical ... and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required.… more
- Molina Healthcare (Columbus, OH)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key… more
- Aston Carter (Johnstown, OH)
- Job Title: Procurement Analyst Job Description Support Procurement Consultants, Procurement Specialists, and Category Managers in the execution of sourcing and ... work, including spend analytics, market complexity data collection, performance metrics, risk considerations, pricing, total cost of ownership, demand planning, and… more