- Amazon (New York, NY)
- …economics reporting and ad-hoc analysis relating to cost of care management - Medicare Risk score projections and premium estimation -Design and implement ... responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and implement an… 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, and ... BIDs, Data Engineers, Data Scientists, and internal/external customers. Essential Functions + Risk Adjustment Analytics & Reporting + Develop and deliver… more
- ChenMed (Miami, FL)
- …+ Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes and Fee For Service. + Knowledge of applicable federal, ... incumbent also serves as a subject matter expert on risk - adjustment and medical economics to aid in...business acumen and acuity + In depth knowledge of Medicare , Medicaid, and commercial billing rules and regulations, coding,… more
- Hartford HealthCare (Farmington, CT)
- …observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition ... capture (HCC) codes, risk adjustment , and other high quality documentation outcome measures. . Management of CDI standard work, workflows, policies, and… more
- 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
- New York State Civil Service (Brooklyn, NY)
- …treatment teams to mitigate potential for infectious disease.* Developing infection control risk assessment and plan along with educational programs for staff and ... Hiring Rate ($10,852), Geographic Pay Differential ($35,000), and Downstate adjustment of $4,000. The posted job rate is the...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …providing needed data and reporting, and partner with actuaries to resolve related risk adjustment issues. The ideal candidate will have experience with ... Encounter Data, Medicare Advantage, Medicaid, ACA commercial, and clinical coding, possess...BI, and will have experience partnering with actuaries on risk adjustment issues. Your Responsibilities * Performs… more
- Deloitte (Colorado Springs, CO)
- …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider...individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or … more
- UCLA Health (Los Angeles, CA)
- …and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk -based audits, ... and more. * Design and improve audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with stakeholders and leadership to identify and… more
- New York State Civil Service (Staten Island, NY)
- …treatment planning.* Participating in multidisciplinary case discussions, high- risk reviews, and administrative meetings.* Maintaining clinical documentation ... will be required.This position is eligible for a Downstate adjustment of $4,000.NOTE: 1. In order to be eligible...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more