- 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
- Somatus (Mclean, VA)
- …5 years of leadership/management experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven ... well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and… more
- Elevance Health (St. Louis, MO)
- …and performs very complex actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + ... an equivalent background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience is strongly… more
- Health First (Rockledge, FL)
- …programs to meet business objectives, CMS regulations and quality standards for Medicare Advantage and IFP Risk Adjustment . * Develop and manage quality ... Provide superior quality by managing and influencing the complex Medicare Advantage (MA) and Individual and Family...appropriate leaders to assist with developing a comprehensive, long-term Medicare and IFP risk adjustment … more
- Point32Health (MA)
- …side of healthcare operations. + Ability to read and understand Medicare Advantage and ACA Risk Adjustment protocols. + Professional, highly organized, ... here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Risk Adjustment Supervisor/Manager, performs accurate and timely review and… more
- Providence (WA)
- … 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
- The Cigna Group (Nashville, TN)
- …Familiar with IT Software Development Lifecycle (SDLC) **Preferred Qualifications:** + Knowledge of Medicare Advantage Risk Adjustment Model (HCC model) ... Summary:** This role is a member of the Encounters Risk Adjustment Submissions team. This team is...of with NUCC and NUBC guidelines + Knowledge of Medicare Regulations and Medicaid State Processing Guidelines + Experience… more
- Providence (OR)
- …we must empower them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform ... coding audits of Hhierarchical Condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors + Perform audits to ensure compliance… more
- Health First (Rockledge, FL)
- *POSITION SUMMARY* This role contributes to Health First Health Plans' (HFHP) Risk Adjustment data collection, supporting compliance with regulatory and ... business. This individual will ensure the integrity of HFHP risk adjustment data by critically analyzing and...Microsoft Access preferred. o Knowledge and understanding of Federal Medicare program, Medicare Advantage Plans,… more