- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Risk Adjustment Compliance Professional 2 supports the organization's ... guidance, and sound judgement in determining appropriate actions within established framework. The Risk Adjustment Compliance Professional 2 contributes… more
- Highmark Health (Raleigh, NC)
- …This job provides end-to-end management, delivery and support to new and existing Risk Adjustment Programs. The incumbent will deliver value to the Health ... business outcomes and achieve strategic objectives relative to new and existing Risk Adjustment Programs. Supports other key objectives designed to… more
- Datavant (Raleigh, NC)
- …using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical ... complex problems with technology-forward solutions. Datavanters bring a diversity of professional , educational and life experiences to realize our bold vision for… more
- Humana (Raleigh, NC)
- …and Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI operations. **Responsibilities** ... factors **Preferred Qualifications** + Experience in Medicare Advantage - risk adjustment or Stars + Degree in...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Truist (Charlotte, NC)
- …Develop appropriate policies and procedural documentation to effectively manage the risk of GAAP non- compliance . Ensure the continual effectiveness of ... to help drive business decisions and strategy while ensuring compliance with regulatory guidelines and US GAAP - Oversee...and business units. - Continuously monitor the financial statement risk to provide input on initiatives to enhance control… more
- CVS Health (Raleigh, NC)
- …Sr Manager, within the Revenue Integrity organization, you will be leading Risk Adjustment technical activities not limited to, reconciliation and aggregation, ... external consultants, team members and/or matrixed staff as required to support MA Risk Adjustment Revenue Integrity initiatives. + Responsible for leading the… more
- RELX INC (Raleigh, NC)
- …matter expertise for Transaction Monitoring (TM) initiatives across the Financial Crimes Compliance (FCC) division of LexisNexis Risk Solutions. In this role, ... About the Business LexisNexis Risk Solutions is the essential partner in the...all functions including product, technology, data operations, marketing, and professional services to ensure an end-to-end focus for data,… more
- CenterWell (Raleigh, NC)
- …efficiencies, processes, education, and compliance as it relates to Medicare Risk Adjustment . Uses data-based insight to direct process improvement efforts ... The Finance Strategy Lead - MRA in the PCO risk adjustment area implements and supports strategy...we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity… more
- CVS Health (Cary, NC)
- …improvements. **Required Qualifications** Minimum 10+ years of experience in healthcare quality, risk adjustment , revenue integrity, or compliance within a ... Medicare Advantage setting. **Preferred Qualifications** Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Professional… more
- RELX INC (Raleigh, NC)
- …has four market segments. It develops information-based analytics and decision tools for professional and business customers in the Risk , Scientific, Technical & ... Legal Department advises the RELX corporate functions and its business divisions (Legal, Risk , Scientific Technical & Medical, and Exhibitions) on various legal and … more