- Blue Cross and Blue Shield of Minnesota (St. Paul, MN)
- …and vendor performance relative to established contracts. Collaborate with actuarial , finance, Medicare and risk adjustment to ensure all inputs and ... Medicare Provider Relations team! You will apply broad actuarial principles and modeling technical skills to develop solutions...with actuarial , finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- EmblemHealth (New York, NY)
- …the appropriate regulatory authority (eg, CMS, New York Dep't of Health). Work closely with Risk Adjustment and other areas to optimize risk adjustment ... analyze current rate structures and develop improvements and alternatives. Coordinate the actuarial staff as needed to support the activities of the affiliates.… more
- Milliman (Seattle, WA)
- …Familiarity with key industry metrics and frameworks, such as HEDIS, population health, risk adjustment , and value-based payment models. Prior experience in a ... actuarial consulting, retirement funding and healthcare financing, enterprise risk management and regulatory compliance, data analytics and business… more
- Elevance Health (Mendota Heights, MN)
- ** Medicare Risk Adjustment Actuarial Analyst III** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... for employment, unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Actuarial Analyst III** is responsible for… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP- ... of America) **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment Services...excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment.… more
- CVS Health (Boston, MA)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior ... Director of Medicare Risk Adjustment and Analytics....Medicare Product, Provider Contracting, Health and Medical Management, Actuarial , and Finance + Actively manage the facilitation of… more
- Highmark Health (Pittsburgh, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop...to identify both opportunities and weaknesses in the government's actuarial risk score models to inform better… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Bring your true colors to blue. Under the direction of the Senior Director of Medicare Risk Adjustment and Analytics, the Associate Director of Risk ... externally. The role is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and… more
- Molina Healthcare (Roswell, NM)
- …Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis ... 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
