- Highmark Health (Cheyenne, WY)
- …and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team… more
- Corewell Health (Grand Rapids, MI)
- We are seeking a highly analytical and detail-oriented Risk Adjustment Reporting Developer to support our organization's Medicare Advantage , ACO, ACA, ... BIDs, Data Engineers, Data Scientists, and internal/external customers. Essential Functions + Risk Adjustment Analytics & Reporting + Develop and deliver… more
- UCLA Health (Los Angeles, CA)
- …Triennial Review, pre-delegation reviews, and more. * Design and improve audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with ... our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug...D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance… more
- Humana (Fort Mitchell, KY)
- **Become a part of our caring community and help us put health first** Scheduler/ Risk Adjustment Representative 3 position is a scheduling role for record ... retrieval associates in Florida. The Scheduler/ Risk Adjustment Representative 3 + Role is...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
- Humana (Tallahassee, FL)
- …innovator, and relationship builder, ensuring alignment with Humana's mission and Medicare Advantage goals. **Primary Responsibilities:** Clinical Engagement & ... understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
- CenterWell (Orlando, FL)
- …Coding Curriculums. In this role, you'll blend your clinical expertise-especially in Medicare Risk Adjustment (MRA) and HCC coding-with instructional ... + Design and develop provider education programs focused on clinical documentation, risk adjustment , and coding accuracy for value-based primary care. +… more
- Highmark Health (Pittsburgh, PA)
- …Federal Segments - Individual, ACA and Senior Markets, Group and Direct Pay Medicare Advantage , Direct Pay Medicare Supplemental and Prescription Drug ... Risk Management** : Strategically develop STARS/Quality and Risk Adjustment initiatives across the Government Business...+ Master's Degree + 10 years of experience in Medicare /Medicaid + 10 years of experience in Sales &… more
- CenterWell (Tampa, FL)
- …a value-based primary care setting. This role uses clinical expertise and knowledge of risk adjustment and coding to present educational materials in a way that ... clinicians, presenting education that aligns with value-based care priorities like risk adjustment accuracy, quality performance, compliance, and effective… more
- Point32Health (Canton, MA)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... and experience working collaboratively with providers. + Preferred: 10-15 years of Medicare Advantage experience. Skill Requirements + Energetic, goal driven… more
- New York State Civil Service (Millbrook, NY)
- …to plan proper home diets. The dietitian provides enhanced supports to minimize the risk of choking, death from over-eating, and maximize the health and safety of ... not limited to:* Monitor the need of high nutritional risk individuals in their assigned area (ie, tube feedings,...that starting salary for this title reflects the Mid-Hudson adjustment . Posted Hiring Salary includes the sum of the… more
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