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From Home Optum Health Coding Risk Adjustment Jobs in Utah

Tendo

Principal Data Scientist

Salt Lake City, UT · On-site +1

$131.75K - $178.25K/yr

... and risk adjustment. The person in this role will access data from multiple sources (public and ... Hands-on experience writing Python code including, but not limited to, machine learning, data ...

Tendo

Principal Data Scientist

Salt Lake City, UT

$131.75K - $178.25K/yr

... and risk adjustment. The person in this role will access data from multiple sources (public and ... Hands-on experience writing Python code including, but not limited to, machine learning, data ...

Tendo

Senior Data Scientist

Salt Lake City, UT · On-site +1

$110.50K - $149.50K/yr

... and risk adjustment. The person in this role will access data from multiple sources (public and ... Hands-on experience writing Python code including, but not limited to, machine learning, data ...

Tendo

Senior Data Scientist

Salt Lake City, UT

$110.50K - $149.50K/yr

... and risk adjustment. The person in this role will access data from multiple sources (public and ... Hands-on experience writing Python code including, but not limited to, machine learning, data ...

Medallion Bank

Credit Risk Manager

Salt Lake City, UT · On-site

... boats, home improvement, and offering loan origination services to fintech partners. We work ... What you will do: * Design, build, and maintain KPI/KRI dashboards tracking portfolio health ...

Intermountain Health

Demonstrates expert level knowledge and understanding of federal and state laws and regulations related to health care billing, coding, reimbursement, contracting, and risk adjustment, such as ...

Medallion Bank

Credit Risk Manager

Salt Lake City, UT · On-site

... boats, home improvement, and offering loan origination services to fintech partners. We work ... What you will do: * Design, build, and maintain KPI/KRI dashboards tracking portfolio health ...

Medallion Bank

Credit Risk Manager

Salt Lake City, UT · Hybrid

... boats, home improvement, and offering loan origination services to fintech partners. We work ... What you will do: * Design, build, and maintain KPI/KRI dashboards tracking portfolio health ...

CenterWell

Data Engineer - Healthcare

Salt Lake City, UT · Remote

$110.80K - $133.10K/yr

... from diverse EHRs, and an understanding of Membership, Medicare Risk Adjustment, and quality ... As the largest provider of senior-focused primary care, a leading provider of home healthcare and a ...

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From Home Optum Health Coding Risk Adjustment information

What is the difference between From Home Optum Health Coding Risk Adjustment vs From Home Optum Health Medical Coding?

AspectFrom Home Optum Health Coding Risk AdjustmentFrom Home Optum Health Medical Coding
CertificationsCCS, CPC, or RHIT/RHIACCS, CPC, or RHIT/RHIA
Work EnvironmentRemote, home-basedRemote, home-based
Industry UsageHealth insurance, risk adjustment programsHealthcare providers, hospital coding
Job FocusRisk adjustment coding for insurance accuracyClinical coding for medical records

While both roles involve medical coding from home, From Home Optum Health Coding Risk Adjustment focuses on coding for insurance risk adjustment programs, requiring specific risk adjustment knowledge. In contrast, From Home Optum Health Medical Coding emphasizes clinical coding for medical records, often in hospital or provider settings. Both roles require similar certifications and offer remote work, but their primary focus and industry applications differ.

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From Home Optum Health Coding Risk Adjustment jobs near you
Consulting Actuary - ACA Risk Adjustment

Consulting Actuary - ACA Risk Adjustment

Blue Cross and Blue Shield of North Carolina

Salt Lake City, UT

$143.62K - $229.79K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 22 days ago

Blue Cross and Blue Shield of North Carolina rating

7.8

Company rating: 7.8 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

164th of 258 rated insurance

Job description

Job Description

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.

What You'll Do

  • Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work

  • Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers

  • Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company

  • Communicate effectively with all levels and divisions within the organization, including Divisional Leadership

  • Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates

  • Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor

  • Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials

What You Bring

  • Bachelor's degree or advanced degree (where required)

  • Member of the American Academy of Actuaries

  • Fellow of the Society of Actuaries

  • 7 years of relevant actuarial experience, related experience may be considered.

  • In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) and have at least 9 years of relevant actuarial experience.

Bonus Points

  • Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred

  • Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred

  • Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.

  • Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations

What You'll Get

  • The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.

  • Work-life balance, flexibility, and the autonomy to do great work.

  • Medical, dental, and vision coverage along with numerous health and wellness programs.

  • Parental leave and support plus adoption and surrogacy assistance.

  • Career development programs and tuition reimbursement for continued education.

  • 401k match including an annual company contribution

  • Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$143,616.00 - $229,786.00

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance

_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

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