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Remote Risk Adjustment Provider Educator Jobs in California

Urrly

Telehealth Nurse Practitioner

Los Angeles, CA · Remote

$600 - $720/day

CA Remote (no travel) * $600-$720/day (1099) * Minimum 24 hrs/week Flexible schedule * Own your ... HEDIS and risk adjustment familiarity * Medicare/Medicaid provider enrollment * Comfortable with ...

Humana

Medical Coder

Vacaville, CA · On-site +1

$21.25 - $28.25/hr

Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you ... Provider onsite education, based on business needs * Collaboration with other market provider ...

Humana

Medical Coder

Vacaville, CA · On-site +1

$21.25 - $28.25/hr

Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you ... Provider onsite education, based on business needs * Collaboration with other market provider ...

Humana

Medical Coder

Vacaville, CA · On-site +1

Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you ... Provider onsite education, based on business needs * Collaboration with other market provider ...

Astrana Health

Manager - Advanced Analytics

Alhambra, CA · Remote

$160K - $170K/yr

Partner with business units like Risk Adjustment and Quality to identify analytical opportunities ... Excellent stakeholder management skills, working across providers, payers, and internal teams.

AmTrust Financial Services, Inc.

This is a remote position. Responsibilities * Inquiry Management: Answer questions and provide ... adjustments. * Client Presentations: Present Strategic Risk management services to potential ...

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Remote Risk Adjustment Provider Educator information

What is the difference between Remote Risk Adjustment Provider Educator vs Remote Risk Adjustment Analyst?

AspectRemote Risk Adjustment Provider EducatorRemote Risk Adjustment Analyst
CredentialsCertifications in risk adjustment, healthcare coding, or related fieldsCertifications in data analysis, healthcare analytics, or coding
Work EnvironmentRemote, educational, training-focusedRemote, data analysis, reporting
Employer & IndustryHealth plans, healthcare providers, education companiesHealth plans, analytics firms, healthcare organizations

The Remote Risk Adjustment Provider Educator primarily focuses on training healthcare providers and staff on risk adjustment processes, requiring educational skills and certifications. In contrast, the Remote Risk Adjustment Analyst analyzes data to identify trends and improve risk scores. Both roles are remote and industry-specific but differ in their core functions and skill sets.

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What are popular job titles related to Remote Risk Adjustment Provider Educator jobs in California? For Remote Risk Adjustment Provider Educator jobs in California, the most frequently searched job titles are:
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Remote Risk Adjustment Provider Educator jobs near you
Risk & Quality Performance Manager (CCD Parsing & Understanding HL7)

Risk & Quality Performance Manager (CCD Parsing & Understanding HL7)

Molina Healthcare

Long Beach, CA • On-site, Remote

$129K/yr

Full-time

Posted 12 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

147th of 261 rated insurance

Job description

Job Description
Job Description
Job Summary
The Risk & Quality Performance Manager position will support Molina's Risk & Quality Solutions (RQS) team. This position collaborates with various departments and stakeholders within Molina to plan, coordinate, and manage resources and execute performance improvement initiatives in alignment with RQS's strategic objectives.
Job Duties
• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategy, analytics, and reporting, including but not limited to: Risk/Quality rate trending and forecasting; provider Risk/Quality measure performance, CAHPS and survey analytics, health equity and SDOH, and engaging external vendors.
• Monitor projects from inception through successful delivery.
• Oversee Risk/Quality data ingestion activities and strategies to optimize completeness and accuracy of EHR/HIE and supplemental data.
• Meet customer expectations and requirements, establish, and maintain effective relationships and gain their trust and respect.
• Draw actionable conclusions, and make decisions as needed while collaborating with other teams.
• Ensure compliance with all regulatory audit guidelines by adhering to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success.
• Partner with other teams to ensure data quality through sequential transformations and identify opportunities to close quality and risk care gaps.
• Proactively communicate risks and issues to stakeholders and leadership.
• Create, review, and approve program documentation, including plans, reports, and records.
• Ensure documentation is updated and accessible to relevant parties.
• Proactively communicate regular status reports to stakeholders, highlighting progress, risks, and issues.
Job Qualifications
REQUIRED EDUCATION:
Bachelor's degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 2+ years of program and/or project management experience in risk adjustment and/or quality
• 2+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems
• 2+ years of data analysis experience utilizing technical skillsets and resources to answer nuanced Risk and Quality questions posed from internal and external partners
• Familiarity with running queries in Microsoft Azure or SQL server
• Healthcare experience and functional risk adjustment and/or quality knowledge
• Mastery of Microsoft Office Suite including Excel and Project
• Experience partnering with various levels of leadership across complex organizations
• Strong quantitative aptitude and problem solving skills
• Intellectual agility and ability to simplify and clearly communicate complex concepts
• Excellent verbal, written and presentation capabilities
• Energetic and collaborative
PREFERRED EDUCATION:
Graduate degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
  • Experience working in a cross-functional, highly matrixed organization
    SQL proficiency
  • Knowledge of healthcare claim elements: CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc.
  • Experience with CCDA/CCD parsing
  • Understanding of HL7(ADT, ORU, etc)
  • Exposure to FHIR APIs
  • Knowledge of clinical coding systems (LOINC, SNOMED, CPT, ICD)
  • Experience working with EHR data (Epic, Athena, Cerner)
  • Knowledge of, and familiarity with, NCQA, CMS, and State regulatory submission requirements

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework desired
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

What Molina Healthcare employees say

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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