- Molina Healthcare (Syracuse, NY)
- **Job Description: Director, Operational Oversight ( Medicare )** **Job Summary** Responsible for planning, developing and directing the implementation of techniques ... to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of CMS risk score methodology, risk score calculation, enrollment, premiums, medical and pharmacy claims, and provider data. Incumbent is… more
- Molina Healthcare (Columbus, GA)
- …License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare ... Administration, etc. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine). **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate.… more
- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful department ... measurements used in both internal and external reporting. You will: + Ensure data quality and accuracy through rigorous assurance checks. + Develop and maintain reports, from ad hoc requests to scheduled production reports. + Write clear specifications and… more
- Specialty Rx, Inc. (Ridgefield Park, NJ)
- Job Description SpecialtyRx is a full-service pharmacy. We need Medicare Part B- Billing Representative with Pharmacy experience in our Ridgefield Park, NJ location. ... Hours: 8:00am-4:00pm, 9-5 or 10-6pm Monday through Friday Must be able to train for 3 weeks onsite with the potential in going remote. Please apply here https://secure3.saashr.com/ta/s6337.careers?CareersSearch and we will be glad to reach out to you to… more
- BlueCross BlueShield of North Carolina (NC)
- …9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + The opportunity ... to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous health and wellness… more
- Providence (OR)
- …them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care coordination, case management and ... care management services to Providence Health Plans(PHP) members + Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease + Case management services include: triage and… more
- Molina Healthcare (Caldwell, ID)
- …or special projects as required. + Must have experience working in Medicare + Must have experience analyzing claims. **Job Qualifications** **REQUIRED EDUCATION:** ... Associate's Degree and/or equivalent combination of education and Health Care related experience of 4+ years **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** 4+ years experience in health care industry in related field **PREFERRED EDUCATION:** Bachelor's… more
- CareFirst (Baltimore, MD)
- …roles. + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial experience). + Strong ... experience with SQL, Power BI, and Excel. + Skill with PowerPoint and experience presenting to a diverse set of stakeholders. + Strong project management skills and ability to manage multiple and diverse stakeholders andleadership roles. + Knowledge of claims… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... Extracts, analyzes, and synthesizes data from various sources to identify risks. Maintain/update SQL model(s), estimate risk scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment… more