- Centene Corporation (Tallahassee, FL)
- …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare ...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- MVP Health Care (Schenectady, NY)
- …of Hierarchical Condition Categories (HCC)s and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare ... innovative thinking and continuous improvement. To achieve this, we're looking for a ** Risk Adjustment Analyst** to join #TeamMVP. This is the opportunity for… more
- Molina Healthcare (Ridgeland, MS)
- **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality ... of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert...MHI RQES and VP Stars in developing the local Medicare Stars work plan and executes on interventions that… more
- Molina Healthcare (WI)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality… more
- Hartford HealthCare (Hartford, CT)
- … to support documentation practices among contracted providers that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. ... settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds...starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters.… more
- Humana (Helena, MT)
- …gained from actual experience of chronic condition documentation and coding audits, risk adjustment program implementation and provider education delivery. ... + Assist providers in understanding the CMS - HCC Risk Adjustment program as a...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… 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
- Amazon (San Francisco, CA)
- …economics reporting and ad-hoc analysis relating to cost of care management - Medicare Risk score projections and premium estimation -Design and implement ... -Value based care contracting support and ongoing financial and risk analysis. -Support ongoing actuarial support for outside auditor...in value-based care, including CMS initiatives such as the Medicare Shared Savings Program (MSSP) and ACO… more
- Blue KC (Kansas City, MO)
- …analysis and forecasting of that data. **Job Description** + Maintains expert knowledge of Medicare Advantage & ACA Risk Adjustment models + Responsible for ... required to perform the functions of the role + Minimum 5 years' experience in Medicare Advantage & ACA Risk Adjustment submission experience **Blue Cross… more
- CVS Health (Helena, MT)
- …auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories CRC (HCC)CPMA (Certified ... 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