- J&J Family of Companies (Seattle, WA)
- …authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, ... regional, local, and account market dynamics including coverage and coding requirements + Grow the knowledge of hub and...departments such as marketing, sales, medical science, SCG, IBG, HCC , and PECS. Serve as subject matter expert regarding… more
- CareFirst (Baltimore, MD)
- …CMS guidelines, monitoring and determining the impact of any changes to the HCC model and supporting actuarial in the calculation risk adjustment revenue. + Assists ... goals are met and propose opportunities in accurate reimbursement based on the HHS- HCC (Hierarchical Condition Code) model. Perform data mining of claims and data to… more
- Centene Corporation (Raleigh, NC)
- …identify high risk areas and potential non-compliance. + Develop models to detect coding anomalies and identify high-risk areas. + Create analytical tools to assess ... and identify opportunities for improvement. + Apply statistical models to detect coding patterns and relevant events. + Present findings to Risk Adjustment, Legal,… more
- MVP Health Care (Schenectady, NY)
- …opportunities and obstacles. + Measure capture rate of Hierarchical Condition Categories ( HCC )s and diagnosis codes related to Risk Adjustment programs to improve ... + Use Clinical Risk Group (CRG) software to target interventions for improved coding for Medicaid members. Calculates ROIs for Risk Adjustment programs. + Maintain… more
- UCLA Health (Los Angeles, CA)
- …key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: $78,500 - ... of common healthcare measurement frameworks and definitions, including Risk Adjustment HCC models from CMS, required + Strong analytical and problem-solving… more
- Dana-Farber Cancer Institute (Boston, MA)
- …Dana-Farber and Dana-Farber/Harvard Cancer Center:** Independently represents the department on DF/ HCC and DFCI committees, including but not limited to Scientific ... Skills: Expert at statistical methodology, and the use of statistical software, coding , data analysis and effective presentation of results. Comfortable with the… more