- 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)
- …+ Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial experience). + Strong ... the organization in making better business decisions. The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience… more
- Molina Healthcare (Tampa, FL)
- …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
- The Cigna Group (Houston, TX)
- …(CPT/ICD10) + Experience with HHS ACA (or Medicare ) risk adjustment models; Healthcare Actuarial Modeling or financial modeling background preferred + ... join the IFP Analytics team responsible for identifying and sizing new risk adjustment opportunities that not only create better health outcomes for patients but… more
- Humana (Louisville, KY)
- …Experience working with medical claims or other healthcare data + Medicare risk adjustment experience + Financial or actuarial background **Additional ... caring community and help us put health first** The Financial Analytics Professional 2 manages data to support and...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Elevance Health (Grand Prairie, TX)
- ** Medicare Risk Adjustment Advanced Analyst Senior** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration ... promoting a dynamic and adaptable workplace. Alternate locations may be considered. The ** Medicare Risk Adjustment Advanced Analyst Senior** is responsible… 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
- 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 ... needs into robust data solutions. + Develop and support risk adjustment financial models that...ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment … more
- Molina Healthcare (NY)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more