- Elevance Health (West Des Moines, IA)
- …complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an Impact** ... + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven… more
- New York State Civil Service (Hauppauge, NY)
- …in the Development Unit is responsible for the timely completion of provider agency development of residential and day services for individuals with intellectual ... architectural feasibility studies ? Review project costs and communicate review with provider agency? Ensure that all project request and/or changes meet the best… more
- CareFirst (Baltimore, MD)
- …strategy. The role serves as a dedicated resource within the organization for Medicare Advantage , Medicaid and ACA markets, coordinating and leading the end ... as HHS, CMS, States, BCBSA, etc. to drive necessary regulatory improvements. + Provide support, education and training to staff to build risk awareness within the… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …+ Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage , and InterPlan Program) + Physician Review Units + ... is responsible for monitoring the quality of the credentialed practitioner/ organizational provider networks ensuring our members receive the highest quality of care… more
- Huron Consulting Group (Chicago, IL)
- …and root cause analysis for benefit-related claims issues. + Support annual Medicare Advantage bid implementation, configuration updates, and release cycles. + ... Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they...experience within a health plan. + Strong understanding of Medicare Advantage , benefit administration, and claims processing.… more
- Commonwealth Care Alliance (Boston, MA)
- …**Desired Experience (nice to have):** + Experience working in a health plan, with Medicare Advantage and/or dually eligible population + Experience with a care ... oversight, routine and post discharge assessments, providing health education, and provider collaboration. Consults, as needed, with other participants of the… more
- Caris Life Sciences (Irving, TX)
- …Billing to support a seamless patient and provider experience. + Provide regular reporting and analysis of eligibility performance , including KPIs, denial ... cross-functional initiatives and manage timelines, resources, and deliverables. + Experience with Medicare Advantage plans and familiarity with Xifin is a plus.… more
- The Iowa Clinic (West Des Moines, IA)
- …operating committee meetings. + Support completion of Commercial, Government, and Medicare Advantage value-based applications. + Develop and distribute ... + Be part of a mission-driven team improving healthcare quality and cost performance . + Collaborate with multidisciplinary teams and provider organizations. +… more
- CareFirst (Baltimore, MD)
- …performing analyses and problem resolution to meet business operational requirements for Medicare Advantage (MA), Affordable Care Act (ACA) & Medicaid Lines of ... overall suite of analytic capabilities and actionable reports to monitor internal performance , oversee vendors, solve problems, provide data-driven guidance, and… more
- CenterWell (Frankfort, KY)
- …with process documentation and re-engineering. + Exposure to senior-focused or Medicare Advantage care models. **Additional Information** + Remote role ... Contribute to continuous improvement efforts focused on enhancing consumer and provider experiences. **Use your skills to make an impact** **Required… more