- 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
- Elevance Health (Mason, OH)
- …is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly preferred + Advanced skills in Microsoft Office ... consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level consultants on… more
- CareOregon (Portland, OR)
- …defined by CMS and AMA + Knowledgeable of CDPS+Rx and CMS Risk Adjustment regulations Skills and Abilities + Advanced ability to read and comprehend medical ... Job Title Risk Adjustment Coding Manager Requisition #...adjustment coding and provider education programs for the Medicare Advantage and Medicaid product lines. This function is… 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 (Bowling Green, KY)
- …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
- Excellus BlueCross BlueShield (Buffalo, NY)
- …right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making ... coding policies to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following… more
- Datavant (Trenton, NJ)
- …+ Knowledge and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... staff/external partners + Oversee the development of complex and advanced ICD-10 and Hierarchical Condition Category (HCC) coding and... Medicare , Commercial and Medicaid risk adjustment business logic and coding +… more
- Molina Healthcare (Green Bay, 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
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... also oversee the improvement of clinical documentation accuracy for Medicare and Exchange members. While under the direction of...in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving… more
- 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 ... better business decisions. The individual will interpret and apply Medicare Advantage Risk Adjustment rules,...Medicare Advantage plan structures. + 4-6 years of advanced experience with MS SQL Server Management Studio. +… more
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