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As the Optum Care National Risk Adjustment Healthcare Economics Team, we support all risk adjustment efforts across our enterprise, primarily focused on Medicare Advantage Risk Modeling.
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Undergraduate degree or equivalent years of experience Bilingual Spanish or Creole including the ability to read and write in both languages Prior community outreach and/or marketing experience Medicare Advantage sales experience Have established book of business within sales territory Knowledge of Medicare supplement and PDP products.
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The Medicare Sales Representative ensures that Communicare Medicare Advantage products are the choice for Medicare eligible individuals in their assigned territory. CommuniCare Advantage , a member of CommuniCare Health Services , is currently recruiting an experienced Sales Representative for our Medicare Advantage plan.
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Sage Health builds enriching neighborhood health centers that are easy to access, provide or arrange for all of our patients' healthcare needs, and partner with Medicare Advantage plans that fully cover primary care.
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The Care Coordinator - Medicare Advantage position on the Population Health team focuses on helping our Medicare Advantage patients. Meet with the commercial insurance payors who administer Medicare Advantage plans; review patient populations, review Bingham's performance, and work with them to help Bingham succeed in managing attributed patients.
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We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. The Sr. Organizational Development Specialist will be critical in developing Medical Mutual's organizational change management center of excellence.
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In cases where Tricare or Medicare/Medicare Advantage is primary or secondary, use scripting to review and deliver appropriate regulatory form (Tricare Rights, Tricare Third Party Liability, and Important Message from Medicare (IMM) form.
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This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational region serving as a liaison between Markets and Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams.
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Experience in key areas of healthcare payer or provider operations, CMS Risk Adjustment and HCC coding process and quality including Medicare Star Ratings and HEDIS. The role requires expertise in areas that include performance management/analytics, data exchanges, electronic medical record systems, provider workflow and processes, health information management, risk adjustment operations (particularly on the prospective side), value-based care, ICD-10, CPT and HCPCS coding principles and guidelines, and population health management.
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Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. About Cigna Healthcare. The role will work under the direction of the Senior Manager - National Lead Provider Education to reach overall operational market goals in conjunction with market Provider Performance Enablement teams and the Risk Adjustment Operations team.
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Documentation Integrity, Coding or Health Information Management Certification through AHIMA, AAPC or ACDIS preferred. Function as a Risk Adjustment and Quality SME to support engagement with market and matrix partners and supports in a consultative way to solution for barriers identified impacting participation with Cigna RA prospective programs.
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Serves as a bridge with market teams and risk adjustment for implementation discussions. The Prospective Program Solutions & Performance Advisor works with aligned region supporting prospective risk adjustment initiatives and programs aimed at improving the accuracy and completeness of risk adjustment, advising the market on risk adjustment strategy based on knowledge of Cigna MA's overall Risk Adjustment programs, with a strong focus on alternate prospective programs and bi-directional data exchange initiatives, and overseeing regional and market program performance.
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Serves as strategic advisor for market specific prospective risk adjustment strategy and solutions. Serve as liaison to share updates with markets/PPE team on risk adjustment programs and strategy. Responsible for identifying and influencing adoption of processes to improve the accuracy and completeness of risk adjustment in the aligned markets.
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories.
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medicare advantage jobs Title: stop loss administrator
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