- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment coding ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Risk Adjustment Auditor Educator** -St. Peter's Health Partners - Full-time - Remote ... **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Molina Healthcare (NY)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Highmark Health (Blue Bell, PA)
- …Develop, oversee and adapt infrastructure (processes, systems, talent) to support an effective risk adjustment program as CMS/HHS/DPW evolves the models and ... for risk revenue management for all government program products (commercial ACA, Medicare , and Medicaid)....direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment … more
- Corewell Health (Grand Rapids, MI)
- …achieving related revenue targets.The role is responsible for helping to achieve the risk adjustment program vision, strategies, objectives, and goals. This ... performance indicators (KPIs) measure productivity, quality and overall impact of the company's risk adjustment program , including reporting KPIs on a… more
- Humana (Louisville, KY)
- …on problems of diverse scope and complexity ranging from moderate to substantial. The Risk Adjustment Organization seeks a Program Delivery Lead for Part ... D Risk Adjustment . This role will partner with leaders to improve...impactful presentations and reports + Strong understanding of the Medicare Advantage program **Role Desirables** + Master's… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …updates, maintaining currency in coding. Evaluates, researches, and recommends enhancements to the risk adjustment program . * Proposes and develops new desk ... right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making… more
- University of Utah Health (Murray, UT)
- …+ Risk Adjustment Analyst position provides support for our health plan's risk adjustment program . + This role is responsible for analyzing medical ... claims, encounter, and risk adjustment targeting data to identify opportunities...Excel). + Familiarity with ICD-10-CM coding, HCC mappings, and risk score calculations. **Qualifications (Preferred)** **Preferred** + Medicare… more
- CareFirst (Baltimore, MD)
- …and manage tracking tools, dashboards, and metrics for monitoring the progress of the Risk Adjustment Program across all lines of business. Drives member ... oversees the outcomes and operations of risk adjustment across the organization within Medicare Advantage,...coding quality. + Successful completion of a Coding Certificate program from an accredited organization (ie, CPC, CRC, CPMA… more
- Tufts Medicine (Burlington, MA)
- …the greater Boston region. **Job Overview** Under the director of the Director, Risk Adjustment Operations, performs accurate and timely reviews and validations ... of Medicare , Medicaid, Commercial HCCs and DxCG's through medical record...established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive… more