- Molina Healthcare (Spokane, WA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB QUALIFICATIONS** **Required… more
- New York State Civil Service (NY)
- …treatment and expert testimony. * Specialized assessment (functional, personality, risk , competency, vocational, education) * Design and application of behavioral ... hiring rate ($25,077), Geographic Pay Differential ($20,000), and Downstate adjustment ($4,000). The Geographic Pay Differential and Downstate adjustment… more
- Centene Corporation (Jefferson City, MO)
- …and Information Set (HEDIS) performance + Responsible for quality improvement aspects of risk adjustment processes for all products + Collaborate with ... Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS) + Oversee provider satisfaction surveys and implement… more
- Genesis Healthcare (PA)
- …topics driving outcomes including, but not limited to: financial performance, risk adjustment , utilization management, quality performance, clinical performance, ... to improve outcomes, enhance care coordination, and drive success in the Medicare Shared Savings Program. We help long-term care providers deliver high quality,… more
- Emanate Health (Covina, CA)
- …MSO personnel on HCC and STAR measures related tasks. Responsible to ensure the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon ... ensure the appropriate ICD10 and CPT codes submitted for Medicare and Covered CA lines of business. Coding specialist...Must have at least one year of experience in Medicare HCC program within IPA, HMO, or clinic setting.… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …cross-functional teams. + Strong understanding of the healthcare payer landscape, with Risk Adjustment experience highly preferred. + Proven experience in ... Solutions Convey Health Solutions (Convey) is the trusted partner for Medicare payers seeking to streamline operations, optimize performance, and elevate member… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment , Stars performance, and member engagement. Pareto's deep ... or analytics platforms preferred. + Familiarity with RFP tracking systems, Medicare Advantage, or value-based care models is highly desirable. Knowledge, Skills,… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... performance improvement and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and modeling and… more
- SSM Health (MO)
- …scoring. + Collaborates with others regardingclinical documentation improvement (CDI) and risk adjustment (mortality) findings. + Maintains knowledge of Centers ... the current health status of network patients against ever-changing risk adjusted models. Responsible for achieving improved documentation results...for Medicare and Medicaid Services (CMS) requirements related to clinical… more
- CenterWell (Hampton, VA)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... improvement and coaching initiatives are precise. + Identify critical issues for high- risk patients during case reviews & other forums, and modeling and driving… more