- Emanate Health (Covina, CA)
- …MSO personnel on HCC and STAR measures related tasks. Responsible to ensure the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon ... ensure the appropriate ICD10 and CPT codes submitted for Medicare and Covered CA lines of business. Coding specialist...**Stewardship.** We wisely care for the human, physical and financial resources entrusted to us. Emanate Health is an… more
- 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... trends. Work with team members to understand and monitor the financial impact of risk adjustment programs. Contribute to developing materials and presenting… more
- Baylor Scott & White Health (Austin, TX)
- + **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
- 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** + ... access for Blue Cross NC customers + Achieve segment financial targets and provide concise explanations of results and...of results and variances to expectations; act as a financial steward for the company + Communicate effectively with… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Point32Health (Canton, MA)
- …will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product ... Actuarial and analytical teams within the department to understand and monitor the financial impact of risk adjustment programs. + **General Management**… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota Career Area: Special ... Lines The Impact You Will Have The Director of Risk Adjustment is a key leader responsible...and driving data integrity, this role enhances care management, risk mitigation, and financial optimization. The ideal… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk adjustment ... the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of...+ Understand CMS risk score methodology, including risk score calculation, financial risk … more
