- Centene Corporation (Tallahassee, FL)
- …from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the ... of compliance issues. Facilitates and leads external audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit deliverables… more
- Molina Healthcare (Jacksonville, FL)
- **Job Description** **Job Summary** The Senior Analyst will serve a key role on the RADV ( Risk Adjustment Data Validation) team, contributing to the ... required for audit response. + Collaborate with internal stakeholders-including IT, Risk Adjustment operations, clinical teams, and retrieval vendors-to ensure… more
- Molina Healthcare (Tampa, FL)
- …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 (Tampa, FL)
- **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 (St. Petersburg, FL)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance.… more
- Molina Healthcare (St. Petersburg, FL)
- …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 (FL)
- …Azure, AWS, or Hadoop + 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment + 3-5 years of experience in working with complex data to ... **Job Description** **Job Summary** The Sr Analyst , Risk and Quality Reporting role supports Molina's Risk and Quality Health Plan team. Designs and develops… more
- Citigroup (Tampa, FL)
- **Finance Reporting Senior Analyst , AVP** The Finance Reporting Senior Analyst is an intermediate level position responsible for the generation, tracking ... transactions, reports and statements in accordance with regulatory guidelines. The Finance Reporting Senior Analyst is responsible for ensuring changes to the US… more
- Molina Healthcare (Jacksonville, FL)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing ... of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's),… more
- CVS Health (Tallahassee, FL)
- …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