- Ankura (New York, NY)
- …operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients. +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …any legally protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota ... Career Area: Special Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is a key leader responsible for shaping risk … more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Director Risk Adjustment Prospective...7 years of relevant experience in Risk Adjustment in a health plan or medical ... strategic leader who initiates, develops and executes/implements the multi-product risk adjustment strategy set by the executive...member disease burden after the point of care.3. Mitigate risk by identifying opportunities in the medical … more
- Datavant (Augusta, ME)
- …for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
- Providence (Portland, OR)
- …work mostly remotely in the states of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you ... will be the cornerstone of our strategic vision. You will oversee risk adjustment programs, spearhead provider education, and enhance engagement to support… more
- Molina Healthcare (St. Petersburg, FL)
- …monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment , Risk Adjustment Data Validation, and ... **Job Description** **Job Summary** The Director , Clinical Data Acquisition is responsible for the...that support business objectives. + HEDIS Operations experience. + Risk Adjustment and Data Validation experience. +… more
- Highmark Health (Pittsburgh, PA)
- …+ Production Coding: Manage a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track production coding results ... to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and… more
- Datavant (Olympia, WA)
- …strategic mindset and a focus on continuous improvement. + Familiarity with CMS HCC risk adjustment processes preferred \#LI-BC1 We are committed to building a ... experiences to realize our bold vision for healthcare. The Director of Client Success will report to the VP...exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its… more
- Ankura (New York, NY)
- …college/university + Current Registered Nurse license + Experience working for payors conducting risk adjustment reviews + Clinical experience in a variety of ... and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside… more
- University of Utah Health (Murray, UT)
- … risk adjustment program. + This role is responsible for analyzing medical claims, encounter, and risk adjustment targeting data to identify ... trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for...leadership, and provider level. + RAD-V audit experience and medical record review. + Advanced SQL skills for large… more