- Corewell Health (Grand Rapids, MI)
- Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and ... role is a key strategic leader who initiates, develops and executes/implements the multi-product risk adjustment strategy set by the executive leaders of Risk… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …any legally protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota ... Career Area: Special Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is a key leader responsible for shaping risk … more
- Datavant (Augusta, ME)
- …for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
- Centene Corporation (Austin, TX)
- …and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to ensure and implement effective prevention,… more
- Highmark Health (Pittsburgh, PA)
- …to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... Coding: Manage a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track production coding results and monitor accuracy… more
- CareFirst (Baltimore, MD)
- … Analytics team is hiring a lead data analyst with deep experience in risk adjustment . This person will support the Director of Risk Adjustment by ... monitoring and reporting on risk adjustment KPIs, delivering insights for prospective and retrospective risk adjustment operational decisions, and… more
- Ankura (New York, NY)
- …operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients. +… more
- Ankura (New York, NY)
- …college/university + Current Registered Nurse license + Experience working for payors conducting risk adjustment reviews + Clinical experience in a variety of ... and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside… more
- Molina Healthcare (St. Petersburg, FL)
- …monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment , Risk Adjustment Data Validation, and ... **Job Description** **Job Summary** The Director , Clinical Data Acquisition is responsible for the...that support business objectives. + HEDIS Operations experience. + Risk Adjustment and Data Validation experience. +… more
- Datavant (Olympia, WA)
- …strategic mindset and a focus on continuous improvement. + Familiarity with CMS HCC risk adjustment processes preferred \#LI-BC1 We are committed to building a ... professional, educational and life experiences to realize our bold vision for healthcare. The Director of Client Success will report to the VP of Client Success and… more