- Molina Healthcare (Columbus, GA)
- **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 (Savannah, GA)
- …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 (Savannah, GA)
- **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 (Savannah, GA)
- …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 (GA)
- …Summary** This Sr. Analyst , Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing ... + Experience developing queries within project management tools like Azure DevOps. + Risk Adjustment experience and some familiarity with Power BI level report… more
- Molina Healthcare (Augusta, GA)
- …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
- RELX INC (Atlanta, GA)
- Senior Third Party Risk Analyst...a disability or other need that requires accommodation or adjustment , please let us know by completing our Applicant ... impact business continuity, security, or compliance? About the role , the Senior 3rd Party Risk Analyst will analyze risks and help operate the enterprise… more
- Molina Healthcare (Augusta, GA)
- **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 (Atlanta, GA)
- …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 (Augusta, GA)
- **JOB DESCRIPTION** **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Healthcare plays a critical role in supporting clinical and operational initiatives ... directly with **clinicians, nurses, or case management teams** + Familiarity with risk adjustment , value-based care models, or healthcare performance metrics +… more
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