- CVS Health (Hartford, CT)
- …solutions to make health care more personal, convenient and affordable. Position Summary The Medicaid Risk Adjustment Sr. Analyst will play a critical role ... economic outcomes, and other business needs. Reporting to the Sr. Manager of Medicaid Risk Adjustment Analytics, the Sr. Analyst will work closely with… more
- CVS Health (Hartford, CT)
- …of Aetna Better Health Medicaid Plans. Reporting to the Senior Manager of Medicaid Risk Adjustment , the Market Manager of Medicaid Risk ... 20% + Recruit, develop and retain a high performing, high quality risk adjustment talent pool that is respected within Medicaid Operations. + Develop the… more
- CVS Health (Tallahassee, FL)
- …in Risk Adjustment payment models for Medicare Advantage, ACA and Medicaid . + Expertise in Risk Adjustment timelines and requirements + Prefer ... redirecting as appropriate. + Confers internally and externally with clients and senior management regarding the organization's goals and objectives. + Coaches the… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supports Risk Adjustment & Stars organization to optimize Risk Adjustment revenue and coding accuracy through ... populations. Responsible for developing performance monitoring reports and analytics related to Risk Adjustment & Stars programs and processes. We are looking… more
- Humana (Columbus, OH)
- …physician, providers and practice managers. + Supporting HEDIS & Risk Adjustment initiatives and Ohio Department of Medicaid quality initiatives for PRAF, ... Service Experience, Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment . Reporting to the Associate Director and/or… more
- Highmark Health (Columbus, OH)
- …Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits. Works closely with colleagues, ... and compliance), and/or physicians to identify and deliver high quality and accurate risk adjustment coding. Supports all risk adjustment projects to… more
- CVS Health (Hartford, CT)
- …has an exciting opportunity for a Senior Informatics Manager to join our dynamic Medicaid Risk Adjustment Analytics team! In this role you will provide ... of audiencesPreferred Qualifications- Knowledge of government-regulated healthcare programs such as Medicaid or Medicare - Risk Adjustment … more
- Humana (Columbus, OH)
- …an in-depth evaluation of variable factors. This job is within the Medicare risk adjustment finance department. This department is a combination of finance, ... caring community and help us put health first** The Senior Software Engineer codes software applications based on business...predicted cost, project future revenue as a result of risk adjustment , and communicate these projections to… more
- Providence (Portland, OR)
- …budgeting and forecasting techniques. + Demonstrated knowledge in risk adjustment models (commercial, ACA, Medicare, and Medicaid ) + Demonstrated knowledge ... risk sharing and alternative payment amounts, and estimating risk adjustment and risk transfer...key analyses with appropriate level of detail analysis for senior leaders. + Manage vendor and consulting relationships. +… more
- Fallon Health (Worcester, MA)
- …Financial and SOC 1 audit requirements + Work flow and internal controls + Risk adjustment and encounter data **Resources:** Microsoft Office Excel, Word, Power ... be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in… more
- Humana (Pittsburgh, PA)
- …market's performance. **Key Functions** + Maintain collaborative relationships (Provider Engagement, Risk Adjustment , Clinical Teams, etc.) + Instill focus on ... live in PA or MD** + Prior Medicare experience + Provider engagement/education, risk adjustment or related experience + Understanding of CMS Stars, performance… more
- Deloitte (Williamsville, NY)
- …with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with health care reform and working knowledge ... Work you'll do As a Government Health Actuary - Senior Consultant in Deloitte's Human Capital Actuarial and Insurance...health plan/insurance company experience + 1 years' experience with Medicaid managed care rate setting + ASA with progression… more
- Healthfirst (NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), ... located at 100 Church Street, NYC. + As a Senior Healthcare Analyst within Medical Economics, you will manage...achieving desired results. + Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst… more
- CVS Health (Topeka, KS)
- …contracting/network + Knowledge of HEDIS and Pay for Performance metrics, ICD-10 coding, Medicaid risk adjustment methodology, and common billing and common ... Charlottesville, VA + San Antonio, TX + Southern, IL Position Summary This Senior Analyst, Healthcare Quality Management will be a Quality Practice Liaison who… more
- CVS Health (Columbus, OH)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management* Actively participate in ... meetings and communication with the state Departments of Medicaid in person as needed* Outward facing position to interact and collaborate with medical / physical… more
- UNC Health Care (Smithfield, NC)
- …necessary escalate to management patient-level issues stemming from contested charges, Risk Management or Patient Relations. 4. Reviews Cosmetic & Elective account ... to resolve credit balances through refunds or posting adjustments. Compiles Medicare/ Medicaid Cash Reports and quarterly Credit Balance reports. 6. Payor Audits… more
- Centene Corporation (New York, NY)
- …development. Collaborates with corporate and market quality leaders, provider engagement, risk adjustment and other Operations business owners or ... Provider Quality Incentive programs, Medicare Stars, Marketplace QRS and State Medicaid P4P Programs required.Pay Range: $84,300.00 - $151,700.00 per year Centene… more
- Molina Healthcare (Las Vegas, NV)
- **JOB DESCRIPTION** **Job Summary** Responsible for continuous quality improvements and risk adjustment accuracy for all government lines of business. Supports ... updates at the meetings and overall, to health plan Senior Leadership Team meetings. + Leads one or more...key providers. + Participates in state level quality and risk adjustment strategy meetings, develops a quality… more
- Humana (Louisville, KY)
- …of the appropriate courses of action. This job is within the Medicare Risk Adjustment Finance department. This department is a combination of finance, ... predicted cost, project future revenue as a result of risk adjustment , and communicate these projections to..., and communicate these projections to other departments and senior leadership. As part of this team you will… more
- CVS Health (Atlanta, GA)
- …review, diagnosis coding, and/or auditing.Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition ... Medicaid Services (CMS) for the purpose of risk adjustment processes. Diagnosis codes must be...and decisions using industry standard evidence and tools. Assists senior level staff in providing recommendations for process improvement… more