- Molina Healthcare (Longview, TX)
- …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures ... Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance… 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 ... Transformation plan is in place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** + Ensures assigned Tier 2 & Tier 3… more
- Apex Health Solutions (Houston, TX)
- …medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with Risk Adjustment requirements. Key Responsibilities Follows CMS Risk ... one of the following is required : Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Certified Coding Specialist (CCS) Registered Health… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …and consumption including but not limited to eligibility, claims, payments and risk adjustment . The Senior Data Engineer supports Pareto Operations. Key ... data, including but not limited to eligibility, claims, payments, and risk adjustment datasets. + Expertise in modeling data in relational databases (eg,… more
- Highmark Health (Cheyenne, WY)
- …anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with ... at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk … more
- Humana (Concord, NH)
- …provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes data and ... leader, tailor's provider group webinars and discussions based on various Risk Adjustment topics. **Use your skills to make an impact** **Required… more
- Hartford HealthCare (Farmington, CT)
- …observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition ... capture (HCC) codes, risk adjustment , and other high quality documentation outcome measures. ....Safety Indicators (PSI), HCC's, Vizient /Elixhauser variables and other risk adjustment variables. . Meets revenue cycle… more
- Basin Electric Power Cooperative (Bismarck, ND)
- …to speak. **KEY SKILLS** + Knowledge of property and casualty insurance, claims adjustment , and risk analysis. + Proficient with personal computers and Microsoft ... Job Title: DIRECTOR/MANAGER, RISK & INSURANCE (DOE) Posting Start Date: 10/3/25...position is responsible to design, establish, and manage the Risk Management (pure risk ) program of Basin… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …performing data analysis, quality assurance, and regulatory submissions with a focus on Risk Adjustment and Medicare Advantage (MA) data. You'll collaborate with ... actuaries and other cross-functional teams to deliver accurate reports, resolve risk adjustment challenges and provide data-driven solutions. This position… more
- Mount Sinai Health System (New York, NY)
- …for driving key population health goals including access, quality, utilization and accurate risk adjustment with a group of practices and (2) close partnership ... with the CDQI Director to drive accurate risk adjustment throughout the system. This Medical Director must be effective at influencing physicians, medical… more