- SSM Health (OK)
- …support an accurateDRGassignment, SOI, and/or ROM.Assists in the mortality review and risk adjustment process utilizing third-party models. + Demonstrates an ... Related Group (DRG) assignments, case-mix index, severity of illness (SOI), and risk of mortality (ROM) profiling, and reimbursement. Facilitates the resolution of… more
- Fallon Health (Worcester, MA)
- …preparation of actuarial components of financial reports, regulatory submissions, and risk adjustment analyses + Collaborate with cross-functional teams ... support key business functions such as pricing, reserving, forecasting, and risk analysis. **Responsibilities** **Primary Job Responsibilities** + Assist in the… more
- NCH (Naples, FL)
- …well as applicable organizational policies and procedures. * Experience in MS-DRG and APR-DRGs, risk adjustment , HACs and PSIs, O/E mortality, and LOS. * Working ... assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or… more
- ChenMed (Miami, FL)
- …CMS public information.Calculatesstatistical and probability forecasts and models from data. + RunsCMS risk adjustment model to calculate member level risk ... our team. The Actuarial Services Analyst is responsible for managing and tracking the risk positions within ChenMed as well as supporting the strategic goals of the… 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...indirectly leading teams. + Advanced knowledge of financial and risk health arrangements. + Strong skills including proficiency in… more
- Sutter Health (Sacramento, CA)
- …finance foundation and solid understanding of provider reimbursement principles-such as risk adjustment , capitation, and fee-for-service-who can apply this ... with Operations and MCF.** + **Validate CMS Medicare Advantage and ACA risk scores, along with payer codes, for accuracy, consistency, and compliance.** +… more
- St. Peters Health (Helena, MT)
- …compliance. Preferred Qualifications + Experience supporting value-based care, population health, or risk adjustment . + Familiarity with HL7, FHIR, ICD-10, CPT, ... containment + Operational efficiency and access + Value-based care and risk -based contracts + Oversee dashboards, KPIs, predictive models, and self-service analytics… more
- WelbeHealth (Salt Lake City, UT)
- …education and experience in coding and auditing + Minimum of two (2) years of Risk Adjustment (HCC) coding experience in a managed care environment + Current ... and participate in provider education programs to ensure compliance with CMS risk adjustments diagnosis coding guidelines + Work closely with Coding Supervisor in… more
- CVS Health (Tallahassee, FL)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management. * Actively participate ... programs to ensure providers deliver appropriate, high-quality, cost-effective Health Risk Assessments and other clinical services that are evidence-based. *… more
- Molina Healthcare (Atlanta, GA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... (APC's), and other payment mechanisms. * Advanced understanding of value-based risk arrangements * Advanced experience in quantifying, measuring, and analyzing… more