- CareFirst (Baltimore, MD)
- …leadership roles. + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial ... a lead data analyst with deep experience in risk adjustment . This person will support the Director of Risk Adjustment by monitoring and reporting… more
- Ankura (New York, NY)
- …investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also support ... master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …any legally protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota ... Career Area: Special Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is a key leader responsible for shaping risk … more
- Providence (Portland, OR)
- …work mostly remotely in the states of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you ... + **Experience:** At least 7 years of experience with Medicare , Medicaid, and Commercial risk adjustment...of experience with Medicare , Medicaid, and Commercial risk adjustment processes within a Healthplan environment… 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
- Fallon Health (Worcester, MA)
- …or follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Senior Director of Risk Adjustment is responsible for the execution and ... success in government & state sponsored risk adjustment program operations, the Senior Director of...Information Systems **Experience:** + 7-10+ years' experience in the risk adjustment and Medicare managed… 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
- Molina Healthcare (Davenport, IA)
- …+ Coordinates accountabilities between segment and markets to drive performance in network, risk adjustment , and stars; single point of contact for escalations ... to mitigate risk and develop/implement improvements across areas that impact Medicare performance. + Collaborate across Medicare segment, with health plans,… more
- Molina Healthcare (Ann Arbor, MI)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare ,… more
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