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This position will support Medicare Risk Adjustment activities including ACO REACH, MSSP and Medicare Advantage activities. The Lead Director position is an experienced career level position with an expertise in business operations in a health care setting with Medicare Risk Adjustment experience a plus.
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Serves both internal and external customers, identifies opportunities for improvement throughout the Medicare risk adjustment process. Experience with Medicare risk adjustment. The Lead Director applies compliance, regulatory, business, analytical and communications skills to support, manage and develop operational solutions to advance Medicare compliant risk adjustment activities for the CVS Accountable Care Organization with national oversight.
$100,000 - $231,500 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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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Job Description - Senior Appeals Specialist-Medicare Advantage (2400193) Senior Appeals Specialist-Medicare Advantage. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.
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Reporting to the SVP, Sales & Client Management, the Director, Group Medicare Sales, is an integral member of the leadership team-driving BCBSMA's purposeful re-entry into the Group Medicare Advantage Market.
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The role will have responsibility for Group Medicare Advantage and Medicare Supplementary new sales, retention, growth and account management strategies for all market segments, including meeting/exceeding long, medium and short-term objectives.
$89ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Data Governance, will be a lead on data validation and quality control with regards to Medicare Advantage Risk Adjustment. The MA Data Ops Developer will be responsible for building, enhancing, maintaining and automating data warehouse structures as well as owning data inflows and outflows that support the Medicare Advantage Risk Adjustment teams and efforts.
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Associate Director, Group Medicare Sales page is loaded. Associate Director, Group Medicare Sales. Minimum of 10 years of proven Healthcare sales or consulting experience; Group Medicare experience preferred.
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The programs the AVP will have oversight for include but are not limited to: MACRA/MIPS, 21st Century CURES, Centers for Medicare and Medicaid Innovation (CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models (AAPM); Medicare Advantage; and commercial payer value programs.
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Must have 3+ years of experience in Medicare/Medicare Advantage along with value based care. Analysis of Medicare Advantage and Accountable Care Organization data primarily.
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Experience in the annual Medicare Advantage bid development process is a plus. Analyze and develop new to market assessments and modeling which includes future Medicare geographic expansion and enhancements / changes to other market segments (Commercial potentially.
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Medicare Risk score projections and Premium estimation. Strong technical programming skills; SQL, R, SAS, Python, Snowflake, Tableau/Looker, Demonstrated data visualization experience; Tableau/Looker, Power BI.
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One Medical is seeking our Head Actuary to join its Actuarial & Strategic Finance Team. This. The Actuarial & Strategic Finance team has exposure to all facets of the business and plays a critical role in shaping the future and strategy of the company through forecasting and analysis of key business drivers.
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Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage. Review provider documentation of diagnostic data from medical record to verify that all Medicare Advantage and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company.
$25 - $35 an hourFull-timeExpandApply NowActive JobUpdated 3 days ago
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