- CVS Health (Boston, MA)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- Centene Corporation (Providence, RI)
- … Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with ... with Contract management and Service Fund teams to implement monitoring of Medicare -specific VBP contracts, including models with upside/downside risk , shared… more
- Centene Corporation (Jefferson City, MO)
- …partners to mitigate performance risks across functional verticals (eg Rx, Network, Risk Adjustment ) + Serve as subject matter expert to internal ... **Position Purpose:** Ensure successful execution, maintenance, and improvement of Medicare /DSNP products. Manage Medicare /DSNP and support issues that… more
- CVS Health (Oklahoma City, OK)
- …and/or auditing. Experience with Medicare and/or Commercial and/or Medicaid Risk . Adjustment process and Hierarchical Condition Categories CRC (HCC). CPMA ... ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
- Marshfield Clinic (Marshfield, WI)
- …stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy ... and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). **JOB… more
- Molina Healthcare (ID)
- …Azure, AWS, or Hadoop + 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment + 3-5 years of experience in working with complex data to ... Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare... Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare /MMP. Assists with research, development, and completion of special… more
- UPMC (Pittsburgh, PA)
- …Plan has an exciting opportunity for a Physician Educator position in the HCC Risk Adjustment Department. This is a full-time position working Monday through ... and documentation in the medical record and the various risk adjustment models of payment. The Physician...Plan. A general understanding of Health care insurance and Medicare managed care is highly preferred for this position,… more
- Molina Healthcare (Madison, WI)
- …The Manager, Provider Engagement establishes strategies and operational directions for risk adjustment and quality improvement. Collaborates with senior ... strategies. Sets and manages performance goals, ensuring providers meet quality and risk adjustment targets through coaching and consistent engagement. Tracks… more
- Molina Healthcare (Syracuse, NY)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures ... Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration...Min 3 years experience improving Quality performance for Medicaid, Medicare , and/or ACA Marketplace programs To all current Molina… more
- WelbeHealth (Los Angeles, CA)
- …Python, R), Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage/Part D payment ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… more