Medicare Risk Adjustment

Data Analyst, Clinical Performance - Telecommute - UnitedHealth Group - Eden Prairie, MN | 8/13/2020

… sm) Enterprise Clinical Performance (ECP) is charged with effectively implementing, monitoring, and executing on clinical documentation and quality programs that promote patient health while improving the provider practice experience with a special focus on Medicare Risk Adjustment and HEDIS. ECP processes on a national level by providing support in all markets served by OptumCare Delivery & OptumCare Services. This position will report into the Enterprise Clinical Performance Associate Director- Business Process …

Medicare Consultant, Practice Performance Manager Hybrid - Field Based in Indiana - UnitedHealth Group - Indianapolis, IN | 8/3/2020

… payment methodology and the importance of proper chart documentation of procedures and diagnosis coding Monitors Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart …

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Medicare Risk Adjustment and Coding Consultant - Field Based in Arizona - UnitedHealth Group - Flagstaff, AZ | 7/9/2020

… in understanding the CMS-HC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart …

Solving the Challenge of High-volume Health Plan Chart Requests | 7/1/2020

The following is a guest article by Steve Mallinak, Senior Vice President of Operations at Ciox . Every year, healthcare providers receive thousands of health plan chart requests. From Medicare Risk Adjustment (MRA) requests to HEDIS requests, Affordable Care Act (ACA) records retrieval, RADV, DRG Audit, CIP and QIP: the alphabet soup of chart request types is long, and providers have to fill every request. The health plans’ demand for records …

NY hospitals receive $1.1B in safety-net funding | Crain’s New York Business | 6/30/2020

… of the drug are expected to be paid by governments and insurers, not patients. MEDICARE RISK ADJUSTMENT: Moorestown, N.J.–based Tabula Rasa HealthCare said Monday that it has launched an online education series for Medicare risk adjustment. The program is designed for physicians, nurses and other clinicians who offer services in value-based care settings, the health-tech company said. That includes programs of all-inclusive care for the elderly …

Tabula Rasa HealthCare’s Risk Adjustment Division Launches New Online Training for Physicians and Other Providers | Globe Newswire | 6/29/2020

… MOORESTOWN, N.J., June 29, 2020 (GLOBE NEWSWIRE) – Tabula Rasa HealthCare ® (TRHC) (NASDAQ: TRHC ), a healthcare technology company advancing the field of medication safety, has launched the “Clinical Documentation Excellence” (CDE) Online Education series for Medicare risk adjustment. The program is designed for physicians, physician assistants, nurse practitioners, and other clinicians who offer services in value-based care settings, including Programs of All-inclusive Care for the Elderly (PACE), Medicare Advantage …

Tabula Rasa HealthCare’s Risk Adjustment Division Launches New Online Training for Physicians … | 6/29/2020

… MOORESTOWN, N.J., June 29, 2020 (GLOBE NEWSWIRE) – Tabula Rasa HealthCare ® (TRHC) (NASDAQ:TRHC), a healthcare technology company advancing the field of medication safety, has launched the “Clinical Documentation Excellence” (CDE) Online Education series for Medicare risk adjustment. The program is designed for physicians, physician assistants, nurse practitioners, and other clinicians who offer services in value-based care settings, including Programs of All-inclusive Care for the Elderly (PACE), Medicare Advantage …

Medicare Risk Adjustment Fraud is Not Victimless | 6/18/2020

… enrolled in an MA plan—involves just a technical record-keeping or administrative dispute with CMS and no actual victims. Risk Adjustment Fraud Has Victims Nothing could be farther from the truth. In fact, Medicare risk adjustment fraud does involve victims. They include: (1) millions of Medicare patients who fail to receive proper medical care because their healthcare providers are more focused on what diagnosis codes they must enter to …

Medicare Consultant - Field based in Lubbock or Amarillo, TX and surrounding area - UnitedHealth Group - Lubbock, TX | 6/17/2020

… and diagnoses coding. Understand Medicare Stars quality program utilizing analytics and identifies and targeted providers Monitor Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven payment methodology with importance of proper chart documentation of procedures and …

4 Ways MSOs Can Help ACOs Succeed with Medicare Risk Adjustment | 4/15/2020

Blog 4.15.20 4 Ways MSOs Can Help ACOs Succeed with Medicare Risk Adjustment Risk adjustment is a complex but vital competency accountable care organizations (ACOs) must develop in order to succeed in CMS’s (MSSP) . Without capturing a complete, accurate picture of member risk during the reporting year, ACOs risk jeopardizing their care management effectiveness. However, many ACOs don’t have the internal expertise to implement a successful risk adjustment program. Healthcare …

Advantmed Launches Virtual Wellness Visits to Keep Patients Safe and Healthy | Business Wire | 4/9/2020

… to the Centers for Medicare & Medicaid Services’ recent expansion of telehealth use under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. CMS further clarified its stance on telehealth for Medicare Risk Adjustment in the Federal Register / Vol. 85, No. 66 / Monday, April 6, 2020, confirming the billing codes, place of service, and billing method to support virtual wellness visits. About Advantmed Advantmed is a healthcare …

DOJ files suit against Anthem for fraud | 3/30/2020

… are confident that our health plans and associates have complied with Medicare Advantage regulations, including those set forth by the Centers for Medicare and Medicaid Services (CMS), and we intend to vigorously defend our Medicare risk adjustment practices,” the insurer told HCB News in an email. “The government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply to original Medicare, and …

DOJ sues Anthem over Medicare fraud claims | FierceHealthcare | 3/27/2020

… good faith efforts to delete inaccurate diagnosis codes,” the lawsuit added. Anthem responded that it is “confident” its health plans and associates complied with federal regulations, Axios reported . “We intend to vigorously defend our Medicare risk adjustment practices,” the insurer “This suit is another pattern that attempts to hold Anthem and other plans to a standard on risk adjustment practices, without providing clear guidance …

Anthem hit with federal lawsuit alleging Medicare fraud | Becker’s Hospital Review | 3/27/2020

… which was the first to report on the lawsuit, Anthem said it is “confident that our health plans and associates have complied with Medicare Advantage regulations.” The insurer, which intends to “vigorously defend” its Medicare risk adjustment practices, said “the government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply to original Medicare, and those inconsistent standards violate the law.” More …

Medicare Consultant - Field based in Southern New Jersey - UnitedHealth Group - Ocean, NJ | 3/18/2020

… payment methodology and the importance of proper chart documentation of procedures and diagnosis coding Monitors Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart …

Medicare Consultant - Field Based in Quad Cities - IA, IL - UnitedHealth Group - Davenport, IA | 1/4/2020

… and diagnoses coding Understand Medicare Stars quality program utilizing analytics and identifies and targeted providers Monitor Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven payment methodology with importance of proper chart documentation of procedures and …

Medicare Risk Adjustment Coding - Inferscience | 11/4/2019

… point of care in real-time. The HCC Assistant is designed to optimize accurate and real-time documentation of the patient conditions critical to predicting the risk. Providers who are looking at improving their medicare risk adjustment coding need to take a serious look at HCC Assistant. Sign up for a demo now …

Actuary- Medicare Risk Adjustment - Humana - Louisville, KY | 11/2/2019

The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization’s short, medium and long-term financial and competitive position. The Actuary, Analytics/Forecasting works on problems of diverse scope and complexity ranging from moderate …

Medicare Consultant - Field Based in Quad Cities, Iowa, Illinois - UnitedHealth Group - Moline, IL | 10/23/2019

… and diagnoses coding Understand Medicare Stars quality program utilizing analytics and identifies and targeted providers Monitor Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven payment methodology with importance of proper chart documentation of procedures and …

Ciox Expands Work With Ardent Health Services | PR Newswire | 9/16/2019

… assisted release model called HealthSource Stream, which accelerates release-of-information processing and improves the quality and richness of data assets. For Ardent, HealthSource Stream will be used to fulfill specific request types, including Medicare Risk Adjustment (MRA) and Disability Determination Services (DDS) requests. “Ciox’s on-site health information specialists, paired with the advanced technological approach of HealthSource Stream, are helping Ardent improve ROI and audit processes, centralize access to …

Medicare Coding Consultant - Field based in New Jersey - UnitedHealth Group - Ocean, NJ | 9/14/2019

… payment methodology and the importance of proper chart documentation of procedures and diagnosis coding Monitors Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart …

Medicare Risk Adjustment and Coding Consultant - Field Based in New Mexico - UnitedHealth Group - Albuquerque, NM | 9/7/2019

… payment methodology and the importance of proper chart documentation of procedures and diagnosis coding Monitors Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart …

Sr Manager of Risk Adjustment Business Analysis- Santa Ana or Nashville - UnitedHealth Group - San Diego, CA | 7/27/2019

Description You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. San Diego, CA Preferred Primary Responsibilities: Serve as a subject matter expert on Medicare Risk Adjustment Consult with clients and relevant internal stakeholders to design and deploy program targeting strategy that is aligned client and internal plans Drive to maximize collaborative and effective processes to ensure alignment and high-quality product …

(USA-KS-Kansas City) Medicare Risk Adjustment and Coding Consultant - Field Based in Kansas City / Springfield / Wichita KS | 7/22/2019

Home View All Jobs ( 2,369,868 ) Job Information UnitedHealth Group Medicare Risk Adjustment and Coding Consultant - Field Based in Kansas City / Springfield / Wichita KS in Kansas City , Kansas The Medicare Consultant is responsible for providing expertise in the area of quality and risk adjustment coding for assigned provider groups. A Medicare Consultant will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing …

(USA-KS-Wichita) Medicare Risk Adjustment and Coding Consultant - Field Based in Kansas City / Springfield / Wichita KS | 7/22/2019

Home View All Jobs ( 2,369,868 ) Job Information UnitedHealth Group Medicare Risk Adjustment and Coding Consultant - Field Based in Kansas City / Springfield / Wichita KS in Wichita , Kansas The Medicare Consultant is responsible for providing expertise in the area of quality and risk adjustment coding for assigned provider groups. A Medicare Consultant will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture …

Medicaid

Tabula Rasa HealthCare’s Risk Adjustment Division Launches New Online Training for Physicians and Other Providers | Globe Newswire | 6/29/2020

… Medicare risk adjustment. The program is designed for physicians, physician assistants, nurse practitioners, and other clinicians who offer services in value-based care settings, including Programs of All-inclusive Care for the Elderly (PACE), Medicare Advantage, managed Medicaid, and Accountable Care Organizations. “Optimizing risk adjustment is complex, and most healthcare professionals have not been trained in Medicare risk adjustment or worked in a value-based environment,” said TRHC Chairman and …

Advantmed Launches Virtual Wellness Visits to Keep Patients Safe and Healthy | Business Wire | 4/9/2020

Medicaid Services’ recent expansion of telehealth use under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. CMS further clarified its stance on telehealth for Medicare Risk Adjustment in the Federal Register / Vol. 85, No. 66 / Monday, April 6, 2020, confirming the billing codes, place of service, and billing method to support virtual wellness visits. About Advantmed Advantmed is a healthcare solutions company providing health plans …

Medicare Advantage

Anthem hit with federal lawsuit alleging Medicare fraud | Becker’s Hospital Review | 3/27/2020

… Anthem submitted the inaccurate codes from 2014 through early 2018 to obtain higher reimbursement for its Medicare Part C, or Medicare Advantage, plans. “Anthem knowingly disregarded its duty to ensure the accuracy of the risk … Advantage regulations.” The insurer, which intends to “vigorously defend” its Medicare risk adjustment practices, said “the government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply …

Genuine Health Group Hires Vice President Of Revenue & Quality | PRWeb | 6/26/2019

… Medicare risk adjustment and quality. As part of her role, she will implement key activities to improve reimbursement accuracy in relation to patient care and quality ratings. Genuine Health Group operates a number of business lines, including a Medicare Accountable Care Organization (ACO) and Management Service Organization (MSO) that manages Medicare Advantage patients under value-based agreements with health plans, and Genuine Health At Home, which provides home-based care …

Clinical Best Practices

Medicare Consultant - Field Based in Quad Cities - IA, IL - UnitedHealth Group - Davenport, IA | 1/4/2020

… for provider clients. A Medicare Consultant will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical … improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven …

Medicare Consultant - Field Based in Quad Cities, Iowa, Illinois - UnitedHealth Group - Moline, IL | 10/23/2019

… for provider clients. A Medicare Consultant will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical … improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven …

Medication Risk Management

Tabula Rasa HealthCare, Inc. (TRHC) CEO Calvin Knowlton on Q3 2019 Results - Earnings Call Transcript | Seeking Alpha | 11/9/2019

… medication risk management, electronic health record, third-party administration, Medicare risk adjustment, and PACE consulting. In addition to multiple new business and client meetings, our annual PACE Appreciation Event attracted over 200 attendees. An Association update outlined that there are 130 PACE organizations in 31 states as of September 1. States with the largest number of providers include California, Michigan, North Carolina and Pennsylvania. As of January 1, 2019, PACE …

TRHC’s Capstone Performance Systems Gains New Clients and Expands Services in 1Q19 | Globe Newswire | 5/14/2019

TRHC’s Capstone Performance Systems Gains New Clients and Expands Services in 1Q19 Technical assistance advising and Medicare risk adjustment services spur growth May 14, 2019 08:00 ET Source: Tabula Rasa HealthCare, Inc. MOORESTOWN, N.J., May … patient outcomes, reduce hospitalizations, lower healthcare costs and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications provide solutions for a range of payers, providers and other healthcare organizations …

Clinical Documentation

Medicare Consultant - Field Based in Quad Cities, Iowa, Illinois - UnitedHealth Group - Moline, IL | 10/23/2019

… assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding. Medicare Consultant will also coordinate implementation of programs designed to … improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven …

Medicare Coding Consultant - Field based in New Jersey - UnitedHealth Group - Ocean, NJ | 9/14/2019

… assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding. He/She will also coordinate implementation of programs designed to … healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC …

UnitedHealth Group

Medicare Consultant - Field Based in Quad Cities, Iowa, Illinois - UnitedHealth Group - Moline, IL | 10/23/2019

… providers Monitor Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive … and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order …

Medicare Coding Consultant - Field based in New Jersey - UnitedHealth Group - Ocean, NJ | 9/14/2019

… Monitors Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition … work.(sm) All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive …

UnitedHealth

Medicare Consultant - Field Based in Quad Cities, Iowa, Illinois - UnitedHealth Group - Moline, IL | 10/23/2019

… providers Monitor Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive … and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order …

Medicare Coding Consultant - Field based in New Jersey - UnitedHealth Group - Ocean, NJ | 9/14/2019

… Monitors Stars quality performance data for providers and promotes improved healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition … work.(sm) All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive …

Optum

Medicare Consultant - Field Based in Quad Cities, Iowa, Illinois - UnitedHealth Group - Moline, IL | 10/23/2019

… position will function in a matrix organization taking direction about job function from UHC M&R but reporting directly to Optum Insight. If you are located in the Quad Cities, you will have the flexibility … improved healthcare outcomes Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven …

Medicare Coding Consultant - Field based in New Jersey - UnitedHealth Group - Ocean, NJ | 9/14/2019

… will function in a matrix organization taking direction about job function from UHC and M&R but reporting directly to Optum Insight. If you are located within Ocean County NJ, you will have the flexibility … healthcare outcomes Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC …

Anthem, Inc.

(USA-AZ-Phoenix) Staff VP Compliance, Medicare Risk Adjustment (PS21260) | 7/9/2019

Anthem Staff VP Compliance, Medicare Risk Adjustment (PS21260) in Phoenix , Arizona Staff VP Compliance, Medicare Risk Adjustment (PS21260) Location: United States Requisition : PS21260 Post Date: May 03, 2019 Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will …

(USA-FL-Clearwater) Staff VP Compliance, Medicare Risk Adjustment (PS21260) | 7/5/2019

Anthem, Inc Staff VP Compliance, Medicare Risk Adjustment (PS21260) in Clearwater , Florida Staff VP Compliance, Medicare Risk Adjustment (PS21260) Location: United States Requisition : PS21260 Post Date: May 03, 2019 Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we …

Humana

Actuary- Medicare Risk Adjustment - Humana - Louisville, KY | 11/2/2019

… works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. In addition, the Actuary will be responsible for: Risk score and revenue projections across Humana’s enterprise Medicare book of business Inter departmental communication across actuarial and financial teams across Humana Key partner in CMS Medicare bid filings, desk review process and bid audits Required Qualifications Bachelor’s Degree FSA or ASA plus …

Actuary- Medicare Risk Adjustment - Humana - Louisville, KY | 10/26/2019

… works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. In addition, the Actuary will be responsible for: Risk score and revenue projections across Humana’s enterprise Medicare book of business Inter departmental communication across actuarial and financial teams across Humana Key partner in CMS Medicare bid filings, desk review process and bid audits Required Qualifications Bachelor’s Degree FSA or ASA plus …