- Hueman Risk Adjustment Solutions (Ballston Lake, NY)
- …is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and ... BLS certification 12 months of experience as a paid advanced clinical provider is preferred but not required To...should be a fundamental part of every role in risk assessment. Our opportunities provide flexibility, extra income, and… 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
- Blue KC (Kansas City, MO)
- …clinical documentation and quality coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state ... + Maintain expert knowledge of ACA risk adjustment regulations + Maintain expert knowledge of Medicare...one and obtain both certifications, CRC and CPC. + Advanced knowledge of ICD10-CM coding. + Proficiency in MS… more
- Tufts Medicine (Burlington, MA)
- …the greater Boston region. **Job Overview** Under the director of the Director, Risk Adjustment Operations, performs accurate and timely reviews and validations ... of Medicare , Medicaid, Commercial HCCs and DxCG's through medical record...established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive… more
- 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
- Molina Healthcare (Roswell, NM)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Datavant (Lincoln, NE)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and ... execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development of robust, scalable, and actionable analytics… 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
- Hartford HealthCare (Hartford, CT)
- …in a variety of settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds relationships, programs, and processes ... recognition programs and other common practices across the system. *JOB SUMMARY:* The Risk Adjustment Coder Educator develops and implements an enterprise-wide … more
- Molina Healthcare (Janesville, WI)
- …medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills to diagnose and manage chronic ... member health outcomes. The NP/PA is responsible for completing advanced practice consultations for enrolled members in the various...+ Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . + Conduct… more
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