- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior ACA Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity ... programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Risk Adjustment **Equal Employment Opportunity ** CareFirst… 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and ... programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Risk Adjustment **Equal Employment Opportunity ** CareFirst… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan has an exciting opportunity for a Risk Adjustment Clinical Auditor/ Analyst position in the Medicare department. This is a full time ... Auditor/ Analyst is an integral part of the Risk Adjustment Department and is responsible for...60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity … more
- Centene Corporation (Jefferson City, MO)
- …from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the ... compliance issues. Facilitates and leads external audits related to Risk Adjustment processes. Ensures visibility by way...be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values… more
- UNC Health Care (Chapel Hill, NC)
- …the health and well-being of the unique communities we serve. Summary: The Risk Adjustment Coordinator will be responsible for analyzing and auditing medical ... payer under the value care contracts. In addition, the Risk Adjustment Coordinator will be responsible for...System, in a department that provides shared services to operations across UNC Health Care; except that, if you… more
- Humana (Louisville, KY)
- …in Medicare regulations and payment models, monitors and reports on risk adjustment data submissions, and supports operations . This role will be responsible ... hybrid based on business discretion. The MRA Finance team supports Humana's Medicare Risk Adjustment business area. The Finance team develops revenue and … more
- Centene Corporation (Jefferson City, MO)
- …the Continental United States. **Position Purpose:** Executes Line 2 oversight of Risk Adjustment activities, including monitoring, auditing, and supports Line 1 ... complete diagnosis coding in alignment with HCCs and other risk adjustment models. Identifies and evaluates clinical...be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values… more
- Centene Corporation (Jefferson City, MO)
- …the Continental United States. **Position Purpose:** Executes Line 2 oversight of Risk Adjustment activities, to include identifying compliance risks, auditing ... findings to business stakeholders to ensure the quality of risk adjustment data. + Ensure coding accuracy...be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values… more
- Molina Healthcare (Bowling Green, KY)
- …DESCRIPTION** **Job Summary** Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk ... sources to identify risks. Additional leadership opportunities are available to lead national risk adjustment studies. Prior experience in Medicaid risk … more