- Mount Sinai Health System (New York, NY)
- …for driving key population health goals including access, quality, utilization and accurate risk adjustment with a group of practices and (2) close partnership ... with the CDQI Director to drive accurate risk adjustment throughout the system. This Medical...all populations served, especially our patients covered under a Medicare arrangement (MSSP or MA). The MD will report… more
- Monogram Health (Fort Myers, FL)
- …HEDIS, Medicaid, Medicare , quality improvement, medical utilization management, and risk adjustment Current state medical license without restrictions to ... each state within the market Experience with high need Medicare Advantage and managed Medicaid populations Experience with NCQA,...practice and free of sanctions from Medicaid or Medicare . Willingness to become licensed in multiple states. MD… more
- Universal Health Services, Inc. (Edinburg, TX)
- …Care Resources. Collaborate with our physicians to educate on proper coding, risk adjustment metrics, capture documentation, and follow quality protocols. ... events. Champion a comprehensive, coordinated model of care for Medicare -aged population on a Medicare Advantage Plan...of care for Medicare -aged population on a Medicare Advantage Plan and Medicaid population. Champions the Attestation… more
- Endeavor Health (Elmhurst, IL)
- …compliant physician reimbursement and for both evaluation/ management, preventive (HCC risk adjustment ) and surgical services under general supervision. ... provider audits on E/M (evaluation/management) services and HCC review on Medicare / Medicare Advantage preventive services and educates providers as needed.… 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… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk ... Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance,… more
- Elevance Health (West Des Moines, IA)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …company seeks a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this critical ... will drive the strategic planning, development, and optimization of our Medicare Advantage Risk Adjustment solution, ensuring that our deliverables support… more
- Humana (Fort Lauderdale, FL)
- …+ Experience with public speaking and presentation skills with healthcare providers + Medicare Risk Adjustment knowledge **Additional Information** Work at ... 4 or more years of medical coding experience + Risk Adjustment knowledge + Proficiency with data...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years.… more
