- 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 ... and billers to ensure the appropriate ICD10 and CPT codes submitted for Medicare and Covered CA lines of business. Coding specialist will be responsible to… more
- Elevance Health (Nashville, TN)
- ** Risk Adjustment Process Expert I** **Location:** Louisville, KY **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering ... an accommodation is granted as required by law. The ** Risk Adjustment Process Expert** is...adjustment experience strongly preferred. + 3 years of Medicare /Medicaid experience is strongly preferred. + Strong oral, written… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of...process and technical workflow documents. + Understand CMS risk score methodology, including risk score calculation,… more
- Humana (Louisville, KY)
- …be considered hybrid based on business discretion. The MRA Finance team supports Humana's Medicare Risk Adjustment business area. The Finance team develops ... + Works with other associates in Corporate Finance and Medicare Risk Adjustment + Distills...and efficiently summarizes the data + Creates and maintains process documentation + Regular use of SQL and Excel… 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 decision-makers. This role supports program management activities around risk adjustment data management and submissions to...Participates in the workgroup to resolve encounter data and process issues. + Analysis and forecasting of risk… 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** + ... If you need a reasonable accommodation for any part of the application or hiring process , please notify HR at ###@bcbsnc.com . **For most roles, you can choose where… 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
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …Graduate. Certified coder CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment / Medicare Advantage and/or clinical. Plans ... the impact of diagnosis coding on risk adjustment payment models. Understand the audit process ...and supporting clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. Medicare and… 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 ... Point32Health (https://www.point32health.org/) . **Job Summary** This position will lead the Risk Adjustment Operations & Provider Consulting team responsible… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …right for you, we encourage you to apply! Job Description: Summary The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making ... ensure accuracy and completeness in diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following… more
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