- Elevance Health (Tampa, FL)
- …and guide provider groups on effective use and interpretation of risk adjustment data and KPIs + Advanced skills in Microsoft Office Suite, especially ... to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions… more
- Molina Healthcare (Tampa, FL)
- …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 (Tallahassee, FL)
- …+ 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
- 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
- Humana (Gainesville, FL)
- …community and help us put health first** The Medical Record Retrieval Specialist ( Risk Adjustment Representative 3) travels to provider offices within the region ... FL area Alachua, Putnam and Marion counties in FL The Medical Record Retrieval Representative ( Risk Adjustment Representative 3): + Travel up to 60% of the time… more
- Bristol Myers Squibb (Miami, FL)
- …Business, Health or Life Sciences, Healthcare Administration, or related field required; advanced degree (MBA, MA Public Health, PharmD, etc.) preferred + 1+ years ... experience including: + Coverage, coding, billing and payment + Medicare (NCD, IPPS, OPPS, 340B, etc.) + Medical policy,...by your state of residence, and 3) a driving risk level deemed acceptable by the Company. \#LI-Field If… more