- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter ... Expert (SME) for risk adjustment with contracted IPAs + Collaborating...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage , STARS/HEDIS program, and NCQA technical… more
- Providence (CA)
- … Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical background + ... providing critical insights to enhance the performance of our Medicare Advantage plans **_Please note the following...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- VNS Health (Manhattan, NY)
- …medical records, including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required + 2 years of ... areas of opportunity to support accuracy clinical documentation. Works with Risk Adjustment and Quality team to identify topics, areas and opportunities for… more
- Robert Half Legal (Houston, TX)
- …in Legal Compliance. * Prior exposure to Medicare Advantage and Medicare Risk Adjustment is required. * A thorough understanding of Federal ... will require knowledge and expertise in Federal Programs such as CMS Medicare Advantage , MMP, D-SNP, and Health Insurance Marketplace plans. Responsibilities:… more
- Molina Healthcare (Lincoln, NE)
- **Job Summary** As the leader for Molina's Medicare Advantage product (Non-Dual), this position has P&L, business strategy, sales distribution and provider ... with senior leadership, determines the annual implementation of Molina's Medicare Advantage product strategic plan. + Has... operations as they relate to compliance, operations, Stars, risk adjustment , network Design, and quality. +… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. _Collaborates ... with internal departments on risk adjustment coding strategies, HEDIS performance, provider...Medicare & Medicaid Services (CMS) regulations pertaining to Medicare Advantage and Affordable Care Act.** +… more
- Molina Healthcare (Covington, KY)
- …well as automated analytical as well as Reporting modules related to Risk Adjustment for Medicaid, Marketplace and Medicare /MMP. + Assist Risk ... **Job Description** **Job Summary** The Sr Analyst, Risk Adjustment - Predicitve Analytics role...like Python and R programming would be an added advantage . + 3-5 Years of experience in Analysis related… more
- Centene Corporation (Jefferson City, MO)
- …advising management concerning state and federal legislation with a focus on Medicare Advantage and Prescription Drug plans, regulations and other requirements ... provides counsel with regards to grievances, appeals and provider dispute resolution, risk adjustment , benefits, sales and broker matters, and provides internal… more
- Marshfield Clinic (Marshfield, WI)
- …to both internal and external stakeholders as it relates to Medicare Advantage , ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and ... policies to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of… more