[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 reputed company programs, risk adjustment methodologies, HCC coding concepts, RAF score optimization, reputed company measures, CMS reimbursement implications, reputed company and performance initiatives
• Experience reputed company plans, managed care organizations, Medicare reputed company 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