- 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
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and vendor performance relative to established contracts. * Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply broad actuarial...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Humana (Montgomery, AL)
- …leaders and their respective functions with a focus on Provider Engagement, Quality and Medicare Risk Adjustment . Represents the health plan externally and ... and developing teams. + Strong knowledge and understanding of Stars and Medicare Risk Adjustment . + Ability to closely partner, build strong relationships… more
- Hartford HealthCare (Farmington, CT)
- …documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the ... documentation practices that comply with CMS on evaluation and management, procedure, risk adjustment program requirements and ICD 10 coding guidelines.… more
- Humana (Little Rock, AR)
- …Business, Finance, Health Care/Administration, RN or a related field + Experience with Medicare Risk Adjustment and/or medical coding + Proven organizational ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor… more