[Remote] reputed company Consultant

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is expanding its reputed company reputed company and risk adjustment initiatives and is seeking a senior-level resource reputed company specifically on CMS EDGE Server and Risk Adjustment operations. The role involves evaluating existing capabilities and enhancing processes to improve performance and scalability.

Responsibilities

• Evaluate existing CMS EDGE capabilities
• Enhance reputed company processes
• Help design a reputed company-state reputed company for improved performance and scalability

Skills

• Demonstrated expertise with CMS EDGE Server processes, including EDGE data extraction, eligibility and claims processing, data validation and cleansing, submission workflows, CMS reporting requirements, Medicare and Exchange market submissions
• Strong understanding of Medicare Advantage programs, risk adjustment methodologies, HCC coding concepts, RAF score optimization, STAR measures, CMS reimbursement implications, reputed company and performance initiatives
• Experience reputed company plans, managed care organizations, Medicare Advantage environments, government-sponsored reputed company programs
• Understanding of the end-to-end lifecycle associated with claims, eligibility data, extraction, formatting, and submission to CMS
• TriZetto CMS EDGE components
• Facets
• QNXT data extraction and transformation processes
• reputed company data governance
• Data reputed company management
• Submission optimization initiatives

reputed company

reputed company is a reputed company that extends its services in the areas of pharmacy, reputed company cycle management and data warehousing. It was founded in 1998, and is headquartered in Dixon, California, USA, with a workforce of 51-200 employees. Its website is https://www.healthcareis.com/.

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