- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. + Analyze… more
- Baylor Scott & White Health (Tallahassee, FL)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... to provide insight to decision-makers. This role supports program management activities around risk adjustment data management and submissions to CMS. This role… more
- TEKsystems (Sunrise, FL)
- …Job Description Position Purpose: Schedule appointments gather medical histories and updated member and provider information in support of member outreach and claims ... reimbursement. Education/Experience: High school diploma or equivalent. 0-2 years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Excel skills.… more
- Elevance Health (FL)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven… more
- Deloitte (Tallahassee, FL)
- …estimates for other Health Plan Actuarial liabilities for Premium Deficiency Reserves, Medicare Risk Adjustment , MLR (Minimum Loss Ratio) Calculations, ... for Incurred But Not Paid (IBNP) claims and Loss Adjustment Expense (LAE) for products covering Medical, Pharmacy, and...Provider Liabilities / Risk -Sharing, and other Contract Reserves / Policy Reserves. +… more
- Centene Corporation (Tallahassee, FL)
- … risk adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare experience preferred Pay Range: ... from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the… more
- Datavant (Tallahassee, FL)
- …and life experiences to realize our bold vision for healthcare. As an Auditor, HCC Risk Adjustment Coder, you will review medical records to identify and code ... using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical… more
- Molina Healthcare (St. Petersburg, FL)
- …+ 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
- CVS Health (FL)
- …and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. + ... codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. +… more
- Molina Healthcare (St. Petersburg, FL)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more