- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the process ... regulatory changes, market dynamic forces, and new competitive threats around Medicare revenue and risk adjustment + Assess new proposals or regulatory… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Bring your true colors to blue. Under the direction of the Senior Director of Medicare Risk Adjustment and Analytics, the Associate Director of ... Medicare and Merged Market segments. The Associate Director of Risk Adjustment Data...is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and… more
- Marshfield Clinic (Marshfield, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Director (Remote/Hybrid) **Cost Center:** 682891390 ... (United States of America) **Job Description:** **JOB SUMMARY** The Risk Adjustment Revenue Director is...strategy and related revenue management for Sanford Health Plan's Medicare , Affordable Care Act and Medicaid business and reports… more
- CareFirst (Baltimore, MD)
- …the organization within Medicare Advantage, Medicaid & ACA markets. The Risk Adjustment Director is responsible for strategic direction, leadership, ... **Resp & Qualifications** **PURPOSE:** The Director , Risk Adjustment oversees the outcomes and operations of risk adjustment across… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and ... role is a key strategic leader who initiates, develops and executes/implements the multi-product risk adjustment strategy set by the executive leaders of Risk… more
- Centene Corporation (Austin, TX)
- …department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to ensure and implement effective prevention,… more
- Highmark Health (Pittsburgh, PA)
- …to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... laws established by the Centers for Medicare and Medicaid Services (CMS), the Department of Health...a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent the … more
- Tufts Medicine (Burlington, MA)
- …as other technical requirements. 4. Summarizes and interprets audit findings for Director Risk Adjustment Operations/NEQCA Leadership; tracks audit results ... over time, identifies trends, and recommends corrective actions. 5. Collaborates with Director Risk Adjustment Operations/NEQCA staff and vendors to identify… more
- CVS Health (Boston, MA)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
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