- NTT DATA North America (Boston, MA)
- …address emerging payer challenges, including **CMS regulations, interoperability mandates, risk adjustment changes, and competitive pressures** **Innovation & ... and provider collaboration + Member acquisition, retention, and digital engagement + Risk adjustment accuracy and compliance + Care management and utilization… more
- Trinity Health (Livonia, MI)
- …outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment , ensuring compliance with reporting standards for claims ... health care delivery system, revenue cycle or consulting experience. + Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Integrity (CDI),… more
- Humana (Olympia, WA)
- …advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor ... a related field, or equivalent work experience. + Experience with Medicare Risk Adjustment and/or medical coding. + Experience with Medicare and/or managed care.… more
- Ascension Health (Austin, TX)
- …the following from AAPC and/or AHIMA: Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Professional Medical Auditor (CPMA), ... Medical Coding experience with at least 2 years specific to Medicare Risk Adjustment /HCC Coding required. + ICD-10 coding experience required. + Experience with… more
- Harvard University (Cambridge, MA)
- …research related to aspects of the Medicare program, including payment policy, risk adjustment , and competition. Experience working with Medicare claims data, ... SAS or Stata) * Demonstrated expertise in causal inference and high-dimensional risk adjustment /predictive modeling, experience with Medicare claims data * Clear… more
- Hawaii Pacific Health (Honolulu, HI)
- …years of clinical experience. **Preferred Qualifications:** Certified Professional Coder - Risk Adjustment (CRC) or Certified Documentation Specialist (CCDS). ... to physicians and advanced practice providers (APPs). Previous experience with risk adjustment coding or clinical documentation improvement (CDI).… more
- UCLA Health (Los Angeles, CA)
- …and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk -based audits, ... contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide...audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with stakeholders and leadership to… more
- Centene Corporation (Harrisburg, PA)
- …of healthcare related experience including quality improvement, HEDIS operations, and Risk Adjustment . Experience with quality rating systems, Medicare products, ... best practices towards achieving market and product quality and risk goals + Serve as subject matter expert in...business requirements and strategies for data capture to close risk and care gaps + Perform root cause analysis,… more
- CenterWell (Indianapolis, IN)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and...as a team + Ensure clinicians effectively co-manage high risk episodes of care and patients with partnered Care… more
- CenterWell (Columbia, SC)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and...care as a team + Ensure clinicians effectively co-manage high- risk episodes of care and patients with partnered Care… more