- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... Serve as a key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: $78,500 -… more
- BlueCross BlueShield of North Carolina (NC)
- …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll ... Get** + The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … Adjustment Coder (CRC) certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), ... military experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment . * Certified Risk… more
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment / Medicare Advantage and/or clinical. Plans experience. Familiarity ... and supporting clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. Medicare and...Risk Adjustment Data Validation (RADV) Timelines. Medicare and Medicaid regulations and billing guidelines and AMA's… more
- Humana (Louisville, KY)
- …Qualifications** + Financial or actuarial background + Medicare Risk Adjustment Experience + Medicare Advantage or Healthcare Industry Experience + ... hybrid based on business discretion. The MRA Finance team supports Humana's Medicare Risk Adjustment business area. The Finance team develops revenue and… more
- Datavant (Indianapolis, IN)
- …an outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and ... up to date with current coding policies for ICD-10, Medicare Advantage , HHS (ACA), and other markets....clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Molina Healthcare (Cincinnati, OH)
- …in Director level role or above. + Extensive understanding of Medicare Advantage , ACA and Medicaid risk adjustment processes, including encounter data ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for...processes that track, evaluate, and submit encounter deletions for Medicare Advantage , ACA, and Medicaid lines of… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment ...+ Prior experience working with EDPS data flows and Medicare Advantage programs is a strong … more
- Molina Healthcare (NY)
- …in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS ... role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling… more
- Highmark Health (Blue Bell, PA)
- …Develop and oversee programs to ensure comprehensive and accurate diagnosis coding for risk adjusted government programs ( Medicare Advantage , ACA business, ... years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement with complex… more