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Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
Starting at $161,914.25 - $315,732.79 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Educate providers on proper coding, risk adjustment metrics, capturing documentation, and adhering to quality protocols. Collaborate to provide a comprehensive, coordinated model of care to a mostly Medicare-aged population on a Medicare Advantage Plan.
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Serve as an internal subject matter expert (SME) and ensure readiness of D-SNP operational functions and performance (e.g., Marketing, Sales, Enrollment, Risk Adjustment, STARs). Manage the annual Medicare/D-SNP plan benefit package design and bid filing with CMS, ensuring accuracy and timeliness of submissions as well as desk review inquiries.
$120,686 - $156,735.06 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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In-depth knowledge of the False Claims Act. In-depth knowledge in one or more of the following payment methodologies: IPF, IRF, CAH, RHC, Home Health/Hospice, Infusion/Injection coding, IPPS, OPPS, MPFS, interventional radiology coding and/or Risk Adjustment.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Your primary objective will be to assess the overall health and well-being of Medicare beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care.
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Wellness risk adjustment assessments for the Medicare population. About AdvantmedAdvantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers.
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Maintains cross-functional relationships with other MVP departments, including but not limited to, Analytics, Risk Adjustment, IT and Technical teams, Health Management, and Operations, to ensure efficient and coordinated efforts.
$56,200ExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Specifically looking for candidate with CMS/Medicare/Encounters/Risk-adjustment/Medical Claims experience within the healthcare domain. Specifically looking for candidate with CMS/Medicare/Encounters/Risk-adjustment/Medical Claims experience within the healthcare domain.
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WellMed is a Medicare Advantage Plan that operates as a health system focused on Quality/Value Based Outcomes. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation.
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In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare and other populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care.
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Prepare and analyze monthly estimates for Medicare Part D Risk Corridor and Coverage Gap Discounts. Monitor changes and updates to the risk adjustment approach employed by CMS.
RemoteExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations.
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Previous in-home Risk Assessment experience preferred. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners.
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We are seeking a highly skilled and compassionate Nurse Practitioner to join our Advantmed provider network. 3 years patient care experience preferred (primary care/adult/geriatric, EMR) Competitive wages (contractor per diem, per completed in-home assessment rate ~$110.
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Keep it real Stay curious & listen well Primary Purpose: We are seeking a highly skilled and compassionate Nurse Practitioner to join our Advantmed provider network. Bring the fun Leverage together for better Outperform yourself Care at every touchpoint Keep your word.
ExpandApply NowActive JobUpdated 4 days ago
medicare risk adjustment jobs
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