- Molina Healthcare (Tampa, FL)
- …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
- Molina Healthcare (WA)
- …with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/ Risk , Director of ... revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge… more
- CenterWell (Jacksonville, FL)
- …(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
- Deloitte (Los Angeles, CA)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- Johns Hopkins University (Baltimore, MD)
- …such as claims processing, premium billing, encounter data, utilization management, risk adjustment , provider contracting, quality metrics, and related ... control procedures, and good business practices; ability to assess risk relative to the proper application of internal controls....risks. + Oversee the development of the internal audit program for projects in assigned audit plan. + Utilize… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and external to ensure accuracy. Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and ... + Leads preparation of accruals/liabilities for CMS Part D risk sharing and Part C revenue settlements. + Leads...statements for assigned business segments. + Leads preparation of Medicare Advantage bids and coordinates CMS bid review responses.… more
- St. Luke's University Health Network (Stroudsburg, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. . Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. . Monitors risk assessment using available tools and implements discharge interventions… more
- St. Luke's University Health Network (Quakertown, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- Henry Ford Health System (Troy, MI)
- …billing and third-party payer regulations. + Knowledge of CMS programs, processes, risk adjustment payment methodology, and payment principles. + Knowledge of ... deletions of codes, use of modifiers, and revenue codes to be compliant with Medicare rules and regulations, the Medicare Billing Manual, the American Medical… more
- Health Care Service Corporation (Mcallen, TX)
- …provider trainings on health plan coding initiative guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation. ... Experience in health insurance or health care setting + Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail… more
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