- Humana (Louisville, KY)
- …to learn. + Works with other associates in Corporate Finance and Medicare Risk Adjustment + Distills complex financial and non- financial data ... discretion. **Preferred Qualifications** + Financial or actuarial background + Medicare Risk Adjustment Experience + Medicare Advantage or Healthcare… more
- Molina Healthcare (Covington, KY)
- …DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... score models. + Generate and distribute routine reports to support risk adjustment calculations, pricing, and financial reporting. + Extract and compile… more
- Baylor Scott & White Health (Frankfort, KY)
- + **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
- Molina Healthcare (Louisville, KY)
- …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
- CVS Health (KY)
- …Summary** CVS Health has an exciting opportunity for a Project Manager to join our Risk Adjustment Analytics team! In this role you will serve as a hybrid ... project manager and subject matter expert in Medicaid Risk Adjustment Medicaid analytics and reporting. You will be responsible for managing State risk … more
- CVS Health (KY)
- …required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred. ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
- Molina Healthcare (KY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to… more
- Molina Healthcare (Covington, KY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to… more
- Humana (Frankfort, KY)
- …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... interrelate across segments and/or enterprise-wide. **Regional VP of Health Services, Humana Medicare Advantage** As the Regional VP of Health Services, you will… more
- Molina Healthcare (Owensboro, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to BH-related RFP sections and review… more