About Us

The RISE Association (Resource Initiative & Society for Education) is a national association dedicated to supporting the health plan and provider organizations involved in the healthcare reform movement, particularly those involved in the government programs markets such as Medicare Parts C & D, Affordable Care Act health insurance exchanges, special needs plans for dually-eligible individuals, Medicaid plans for needy populations, Accountable Care Organizations and MACRA initiatives. 

 

RISE Vision and Mission

To build a community and an educational system that promotes successful careers for professionals who are advancing the Triple Aim of healthcare. RISE provides:

  • A forum to build professional identity and a network of colleagues
  • A platform to capture and share knowledge and insights
  • A venue to develop and share benchmarks and document best practices
  • Career track development support
  • A channel for building alliances, partnerships and affiliations that fulfill the vision

RISE is the first national association totally dedicated to supporting healthcare professionals who aspire to meet the challenges of the emerging landscape of accountable care and healthcare reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development.

  • Education: Through cutting-edge conferences, webcast presentations, job-specific educational curricula, and industry-driven library resources, RISE provides our members with the crucial information they need to stay ahead of the curve. We also actively apply to industry credentialing organizations to ensure that professionals optimize every opportunity our programs offer to earn CEUs.
  • Industry Intelligence: RISE brings the marketplace to members in a collaboration between technical experts, solutions vendors and expert speakers.
  • Networking: RISE members make valuable connections with other healthcare professionals from across the nation, from every section of the industry. Through meaningful networking opportunities and roundtables, RISE brings together multiple perspectives and facilitates highly interactive discussion between professionals. Members hear the best (and worst) practices directly from their peers, and gain valuable insight into market trends.
  • Career Development: RISE members will have access to support tools, career-oriented curricula and networking to enhance their job skills and career tracks.

Who Should Join

RISE was designed to bring together healthcare professionals from all industry segments whose job functions are directly impacted by the continuing evolution of accountable healthcare financing and delivery, health care reform developments, and emerging topics.

Members include professionals working for:

  • Health Plans
  • Physician Organizations, Medical Groups, IPAs
  • Accountable Care Organizations
  • Management Services Organizations & practice management
  • Hospitals & integrated delivery systems
  • Skilled Nursing, Long Term Care and Chronic Care Facilities
  • Medical homes  
  • Sole proprietors or independent consultants 
  • People who are in transition between jobs that would otherwise qualify them for standard membership

With a range of positions: C-Suite roles, Vice Presidents, Directors, Managers, Supervisors and Professional Staff for

  • Quality assurance/improvement
  • Care Coordination, Medical Management, Population Health
  • HEDIS, Stars, Quality Measurement or  Marketplace/QRS
  • HCC coding & revenue
  • Risk adjustment and financial management
  • Compliance and government relations
  • Medical informatics
  • Network development & management
  • Provider engagement
  • Data analytics
  • Operations, claims, member service, enrollment, billing & reconciliation
  • Physician education & engagement
  • Product development & innovation
  • Medicare marketing & sales
  • Member engagement
  • Health Insurance Exchanges and the new Marketplace products
  • Business development & strategic planning

Benefits of Membership

Healthcare professionals are eligible for Standard Membership with RISE, which grants access to:

  • RISE-exclusive webcasts and educational webinars throughout the year
  • RFP Support for identifying qualified vendor support services and competitive bidding
  • Updates on the development of formal educational courses and career support tool development
  • Priority notification of RISE conferences and webinars

Membership Composition

 

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Association Sponsors

Latest Posts

Find More, Spend Less, Take Control: Leveraging Technology to Improve the ROI on Risk Adjustment

Due to changing market dynamics, there is increasing pressure for risk-bearing organizations to improve the effectiveness of their risk adjustment programs. Several trends present pervasive challenges—for example, increasing number of risk-adjusted lives, rising coding intensity factor, and heightened focus on compliance. Risk adjustment departments are constantly being asked to do more with less. Organizations that can leverage risk adjustment as a strategic asset and effectively utilize technology will be best positioned to achieve accurate risk and revenue capture while simultaneously decreasing costs. Streamlining Risk Adjustment with Technology As organizations seek to modernize their risk adjustment operations, there are several high value technology initiatives they can explore. Rather than blindly reviewing charts across the entire membership, organizations can use natural language processing (NLP) technology on medical records to help identify risk adjustment gaps, both for additional HCC capture and for potential deletes. Health Fidelity has been able to consistently demonstrate with our clients that NLP-assisted coding delivers superior results as compared to human-only reviews, both when our clients are conducting the coding and when our coders provide the coding capacity....
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Boomerquake

Medicare products are expected to be the fastest growing insurance sector over the next 10-years. At the same time, Boomers are transforming care delivery, from aging-at-home services to convenience-driven alternate sites of care such as retail clinics, telemedicine and wearables to anti-aging nutraceuticals. Opportunity abounds. What’s clear is the need to understand Boomers – what’s important to them, what truly matters to them, and why they do what they do – has never been more important. For marketers this means a shift in orientation from brand promotion to individual inspiration, from features and functions to emotional appeals that move people to act and engage. It’s about connecting with Boomers around personal, relevant motivations and deep, sometimes even unconscious desires, like freedom, happiness, renewed goals, or simply the ability to enjoy life. A quick snapshot of 75+ million Boomers ages 51 to 69: ...
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Upcoming Conference

 

RISE Risk Adjustment Academy: CMS & HHS Risk Adjustment 101 and HCC Coding Accuracy

Designed as an introduction or refresher that covers all the bases when working with Medicare Advantage or on commercial health insurance exchanges lines of business. The workshop program is a holistic orientation to the risk adjustment panorama and deep dive into HCC coding for accuracy. With a mix of health plan and provider audiences, a powerful environment for interaction and collaboration is built over two-days. You will gain insight, tips, and best practices to build upon your knowledge of risk adjustment, coding, and documentation.

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Upcoming Webinar

Protecting Risk Adjusted Revenue in Small and Mid-Tier Health Plans

If you’ve ever heard the phrase “working without a net” then you’ve heard a phrase that accurately describes the status of risk-adjusted revenue for small and mid-tier health plans. And when you’re working without that net, you’ve got to secure every dollar possible. Easier said than done given the inherent complexity of the encounter management lifecycle and the constant changes and updates that continue to vex managed care plans of all types. What’s required is a simple, best practice approach to encounter data management that is built to serve the needs of health plans regardless of their size. Implementing a best practice approach for small and mid-tier managed care health plans to protect and grow risk-adjusted revenue begins by joining Edifecs for this impactful, actionable webinar.

 

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