- 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… more
- 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...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- CareOregon (Portland, OR)
- Job Title Risk Adjustment Coding Manager Requisition # 24887 Exemption Status Exempt Management Level Manager Direct Reports Coding Auditors Manager Title ... Director, Risk Adjustment Pay and Benefits Estimated hiring...adjustment coding and provider education programs for the Medicare Advantage and Medicaid product lines. This function is… more
- Highmark Health (Pittsburgh, PA)
- …Develop, oversee and adapt infrastructure (processes, systems, talent) to support an effective risk adjustment program as CMS/HHS/DPW evolves the models and ... for risk revenue management for all government program products (commercial ACA, Medicare , and Medicaid)....direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment … more
- Molina Healthcare (Bowling Green, KY)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …updates, maintaining currency in coding. Evaluates, researches, and recommends enhancements to the risk adjustment program . * Proposes and develops new desk ... right for you, we encourage you to apply! Job Description: Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making… more
- Molina Healthcare (New York, NY)
- **Job Description** **Job Summary** The Director, Quality & Risk Adjustment is responsible for leading health plan execution for Risk and Quality ensuring ... of Quality Discipline including metrics and performance standards. Working knowledge of Risk Adjustment . + Project management experience, in a managed healthcare… more
- Marshfield Clinic (Marshfield, WI)
- …Risk Adjustment Services is a key leader for commercial and government program actuarial and risk adjustment topics. This role provides financial ... in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP-Actuarial...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- CVS Health (Albany, NY)
- …Health has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will support data analysis, ... Medicare or Medicaid - Knowledge of health insurance concepts - Experience working in risk adjustment - Experience working at a health plan - Attention to… more
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
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