- Humana (Salt Lake City, UT)
- …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
- University of Michigan (Ann Arbor, MI)
- …impact of insurer-practice integration on patient access and quality. **2. Upcoding and risk adjustment in Medicare Accountable Care Organizations (ACOs)** ... candidate will manage, clean, and analyze administrative datasets (eg, Medicare claims, prescribing, and corporate ownership data); write reproducible...expected health risk a process known as risk adjustment . Yet this system can be… 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
- Blue KC (Kansas City, MO)
- …groups. + Analyze data and monitor provider metrics to identify risk adjustment , HEDIS or educational opportunities for the Medicare Advantage and Qualified ... programs focused on improving the quality of care for Medicare Advantage & Qualified Health Plan (ACA) Members. +...+ Provide training on Stars measures, risk adjustment coding practices, and Blue KC program … more
- Amazon (IL)
- …email requests in a timely manner. Work collaboratively with the Medicare Risk Operations team to ensure positive program outcomes. Basic Qualifications * 2+ ... current on CPT, ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance. Assign appropriate ICD-10-CM, CPT, and other relevant… more
- Molina Healthcare (Iowa City, IA)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives ... Practice Transformation plan is in place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** + Ensures assigned Tier 2 &… more
- Amazon (Seattle, WA)
- …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
- Humana (Cheyenne, WY)
- …internal teams and vendors to resolve issues and maintain compliance with CMS and Medicare Risk Adjustment requirements. + Support auditing processes for ... critical claims operations that ensure compliance and accuracy for Medicare members. As a Senior Program Delivery...accuracy for Medicare members. As a Senior Program Delivery Professional, you'll manage vendor claims processes, monitor… more
- Health Care Service Corporation (Chicago, IL)
- …key performance indicators, trends, and financial acumen + Knowledge of Medicare Stars, Medicare Risk Adjustment , and Medicare Finance. + Strong ... the team to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive provider network… more