• Lead Data Analyst (Remote) - Medicare

    CareFirst (Baltimore, MD)
    …**Preferred Qualifications:** + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical, submission cycle, and ... **Resp & Qualifications** **PURPOSE:** The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience in risk more
    CareFirst (03/27/25)
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  • Clinical Documentation Integrity Specialist…

    UCLA Health (Los Angeles, CA)
    Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment coding ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. You will: + Conduct medical record… more
    UCLA Health (02/19/25)
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  • Medicare Advantage Risk

    UCLA Health (Los Angeles, CA)
    Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter Expert ... (SME) for risk adjustment with contracted IPAs + Collaborating...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage, STARS/HEDIS program, and NCQA technical specifications, a… more
    UCLA Health (04/24/25)
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  • Business Consultant Sr ( Medicare

    Elevance Health (Mason, OH)
    …effectively consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level ... Medicare is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly preferred + Advanced skills in… more
    Elevance Health (05/01/25)
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  • VP Risk Adjustment Accuracy…

    Highmark Health (Pittsburgh, PA)
    …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Development and Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs… more
    Highmark Health (04/30/25)
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  • Director for Quality and Risk

    Robert Half Accountemps (Long Beach, CA)
    …for leading enterprise development of the Medicare Star Ratings and Enterprise Risk Adjustment strategies that ensure our risk adjusted and Star ... and military experience will be considered. . Strong knowledge of Medicare Star Ratings and risk adjustment programs. . Demonstrated ability to lead… more
    Robert Half Accountemps (04/04/25)
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  • Risk Adjustment Trainer

    Datavant (Trenton, NJ)
    …+ Knowledge and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... Medicare , Commercial and Medicaid risk adjustment business logic and coding + Knowledge and understanding of health insurance plans operations + Deep… more
    Datavant (05/07/25)
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  • Risk and Quality Provider Educator

    VNS Health (Manhattan, NY)
    …records, including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required + 2 years of experience in ... identifying opportunities to support precise clinical documentation. Collaborating with the Risk Adjustment and Quality teams, you'll help shape educational… more
    VNS Health (03/04/25)
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  • Lead Data Analyst

    System One (Baltimore, MD)
    …of experience as a Data Analyst. + 3-5 years of hands-on experience specifically in Medicare Risk Adjustment . + Strong understanding of CMS guidelines, RA ... making better business decisions. The individual will interpret and apply Medicare Advantage Risk Adjustment rules, regulations, and processes in analytics… more
    System One (04/19/25)
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  • Clinical Data Abstraction Specialist

    Apex Health Solutions (Houston, TX)
    …Current AAPC or AHIMA credential required. Managed Care Experience preferred. Knowledge of Medicare Risk Adjustment required. About Apex Health Solutions ... Specialist Supervisor: Director, VBC Operations Required License(s)/ Certification(s): Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC),… more
    Apex Health Solutions (04/25/25)
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