- 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
- Humana (Columbus, OH)
- …executive to join the Healthcare Quality Reporting and Improvement (HQRI) organization as Senior Vice President (SVP), Risk Adjustment Operations and ... limited to: + Medical Record Retrieval for all Medicare, Medicaid and Commercial Risk + Adjustment...and executive presence that will ensure effective interaction with senior and executive level audiences, both internally and externally.… more
- Elevance Health (Woodland Hills, CA)
- …including facilitation, consultation, negotiation and persuasion preferred. . Experience with multiple risk adjustment models (MA, ACA, Medicaid ) and markets ... **Director of Medicare Risk Adjustment Analytics and Reporting** **Location:**.... Reports project status and progress to business unit senior management. . Ensures accuracy and timeliness of output… more
- Guidehouse (Atlanta, GA)
- …Capitation rate development, + Valuation of Incurred But Not Reported (IBNR) Estimates, + Risk adjustment calculations of premium, + Analysis of MLR and other ... Over 21% of the US population receive healthcare through Medicaid , and our team supports that important work by...so will have the opportunity to progress to the Senior Consultant level. **What You Will Need:** + 1-3… 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
- 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
- CVS Health (Tallahassee, FL)
- …diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories ... Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in… 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
- 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 (New York, NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... needs to produce results and deliver impactful business recommendations. As a Senior Medical Economics Analyst, you'll map out and construct detailed analyses,… more
- Humana (Columbus, OH)
- …similar **Preferred Qualifications** + Knowledge and/or experience within the Stars Organization, Risk Adjustment and/or Provider. + PMP or CAPM Certification + ... a part of our caring community and help us put health first** The Senior Product Manager Conceives of, develops, delivers, and manages products for customer use. The… 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
- CVS Health (Albany, NY)
- …of Disease (ICD) codes required. * Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories ... results to the appropriate departments and management. + Assists senior staff in providing recommendations for process improvements to... Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… 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 (Albany, NY)
- …and/or auditing. Preferred Qualifications + 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 are appropriate, accurate, and...decisions using industry standard evidence and tools. + Assists senior level staff in providing recommendations for process improvement… more
- Guidehouse (Atlanta, GA)
- …include actuarial modeling tasks such as developing healthcare projections, analyzing risk adjustment impacts, and designing and evaluating value-based contracts ... payments (VBPs), and other pilot program models + Capitation rate development + Risk adjustment calculations of premium + Development of budget projections +… more