- Molina Healthcare (Grand Island, NE)
- …and confirm required data elements. + Collaborate with internal teams-including IT, Risk Adjustment operations , and clinical teams-to ensure accurate ... Analyst will play a supporting role on the RADV ( Risk Adjustment Data Validation) team, assisting in...team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of… more
- Ankura (New York, NY)
- …an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations , internal audit , or compliance either within industry or ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit , and investigation projects for… more
- Corewell Health (Grand Rapids, MI)
- …and efficiency.This leader will be responsible for building out core health plan-based risk adjustment operations , as well as developing innovative ... Job Summary The Director Risk Adjustment Prospective Operations ...goals including but not limited to provider incentive programs, audit and compliance processes and well as EMR optimization… more
- University of Utah Health (Murray, UT)
- …information to Compliance and Audit partners for awareness of trends, processes, and risk adjustment issues. + Works closely with Compliance and Audit ... trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for...University of Utah Hospitals and Clinics represents our clinical operations for the larger health system. **Responsibilities** + Performs… more
- Datavant (Augusta, ME)
- …vision for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
- Commonwealth Care Alliance (Boston, MA)
- …and enrollment teams to improve systems integration and enhance the risk adjustment data ecosystem. + Support audit readiness and regulatory compliance for ... the Director of Encounter Data Management within the Revenue Cycle Department, the Risk Adjustment Data Developer is responsible for the design, development, and… more
- Highmark Health (Blue Bell, PA)
- … Management governance strategy for the Enterprise to appropriately manage CMS audit risk . **ESSENTIAL RESPONSIBILITIES:** 1. Program Development and Management: ... + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs to ensure comprehensive and… more
- Molina Healthcare (Albuquerque, NM)
- …chart retrieval, file transmissions, and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, ... the daily operations of all aspects of risk adjustment data validation related activities, including,...adjustment payment in all markets * Performs monthly audit on internal Molina Coding Specialists * Audits external… more
- Centene Corporation (Austin, TX)
- …and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to...to responsibilities of the team and compliance of business operations for which you oversee. + Educates, encourages, and… more
- Highmark Health (Pittsburgh, PA)
- …to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and...a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track… more