- Elevance Health (Norfolk, VA)
- ** Risk Adjustment Advanced Analyst Senior** **Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 ... miles of one of our Elevance Health PulsePoint locations.** The ** Risk Adjustment Advanced Analyst Senior** is responsible for creating statistical models to… more
- Medical Mutual of Ohio (OH)
- … Supplement, and individual plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance, and ... agreements.** + **Acts as project manager over large internal risk adjustment projects (eg, Optum In Office...& Certifications** + **Strong knowledge of the MarketPlace and Medicare within a managed care insurance industry.** + **Knowledge… more
- Point32Health (Canton, MA)
- …individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD), including submissions to CMS and state ... timely resolution of production issues pertaining to state government and risk adjustment data submissions, including issue investigation, business requirements,… more
- Molina Healthcare (Lincoln, NE)
- … Medicare Advantage operations as they relate to compliance, operations, Stars, risk adjustment , network Design, and quality. + Development and maintenance of ... **Job Summary** As the leader for Molina's Medicare Advantage product (Non-Dual), this position has P&L,...desirable, but not required. + Bachelor's degree is required. Advanced degree (MBA) preferred. + Bachelor's degree and at… more
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... also oversee the improvement of clinical documentation accuracy for Medicare and Exchange members. While under the direction of...in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving… more
- Medical Mutual of Ohio (OH)
- …of life. **Responsibilities** **Medical Record Retrieval Specialist** Supports the company's risk adjustment projects by collaborating with vendors and provider ... offices/facilities to retrieve medical records. Supports other initiatives related to Risk Adjustment Programs (RAPS) and Healthcare Effectiveness Data and… more
- CVS Health (Overland Park, KS)
- …Medicare Advantage, MSSP, ACO REACH).** **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk ... partners and ACOs through the use of actuarial and advanced analytics techniques + Proactively identify areas of opportunities...Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis -Excellent oral &… more
- Humana (Louisville, KY)
- …advancing the care experience of our members and provider partners through integrated risk adjustment (RA) and quality (Stars) solutions that leverage data and ... customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS).The CMS Stars quality rating system evaluates Medicare… more
- AdventHealth (Overland Park, KS)
- …communities of southeastern Johnson County, with 24/7 emergency room services, an advanced imaging center, physical therapy and more. **The role you'll contribute:** ... coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at-… more
- AdventHealth (La Grange, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care team). The Social Work Care… more