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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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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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3 years HCC coding and/or coding and billing. 5 years HCC coding and/or coding and billing. Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.
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Adheres to CMS Guidelines for Coding and Highmarks Policy and Procedures to guide HCC coding decision making. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.
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The actuary will be a key person on the CVS Accountable Care team that analyzes various sources of patient health and claims data to help the business better understand, forecast and manage the risk position of various value-based products (MSSP, ACO REACH, Medicare Advantage.
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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. PALS: Children Services, Cardiovascular Lab, Emergency Department, GI Lab, Interventional Radiology, Surgical Services Pre-Op and Recovery Room.
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Medicare Advantage (MA) risk adjustment is responsible for the development and management of pricing, forecasting, and reporting architecture related to CMS risk-adjustable revenue for Medicare related products within Emerging Markets.
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Requirements: MINIMUM QUALIFICATIONS A Master's Degree in Audiology;Minimum three years of clinical experience with Audiological Evaluations, Hearing Aid Dispensing; assessment across the age range;Current ASHA Certificate of Clinical Competence in Audiology (ASHA CCC-A);Be eligible for NYS licensure in Audiology and Hearing Aid Dispenser license;Be eligible for enrollment with major third-party insurances, Medicare and Advantage Plans.
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The actuary will be a key person on the Accountable Care team that analyzesvarious sources of patient health and claims data to help the business understand, forecast and manage the risk position of various value-based products (MSSP, ACO REACH, Medicare Advantage.
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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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Job Description :Audit & Reimbursement III - Medicare Cost Report AuditLocations: This is a virtual position; the ideal candidate will live within 50 miles of an Elevance Health PulsePoint location.
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medicare advantage jobs Company: Guidehouse
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