Medicare Risk Adjustment Business Information Consultant Sr

About the position

This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Responsible for coordinating and consolidating various impact analyses for management reporting.

Responsibilities

• Conduct comprehensive research and analysis to identify trends, areas for improvement, and opportunities within Medicare markets and provider networks.
• Gather and analyze data to develop insights aimed at optimizing provider performance.
• Identify innovative solutions tailored to address specific provider needs and challenges.
• Collaborate with cross-functional teams to develop strategies and action plans for implementing solutions.
• Present research findings and proposed solutions to providers clearly and persuasively.
• Build and maintain strong relationships with providers to facilitate collaboration and acceptance of solutions.
• Contribute to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes.
• Monitor the effectiveness of implemented solutions and make necessary adjustments to ensure optimal outcomes.
• Develop metrics and KPIs to track the success of solutions and improvements.
• Prepare comprehensive reports and dashboards to communicate performance improvements to stakeholders.
• Serve as a strategic partner to the business and contribute to ideas and solutions.
• Influence others and work effectively to establish and develop working relationships both internally and externally with business stakeholders.
• Serve as a subject matter expert on Risk Adjustment programs and risk adjustment payment methodology.
• Lead and consult with operations on ad hoc requests/special projects.

Requirements

• Requires a BA/BS degree in Statistics, Economics, or Business Administration and minimum of 8 years of relevant experience; or any combination of education and experience which would provide an equivalent background.

Nice-to-haves

• Strong analytical, organizational, presentation, and problem-solving, critical thinking skills strongly preferred.
• Healthcare business knowledge related to Risk Adjustment Payment Methodology.
• Proven track record of successfully implementing provider solutions that led to measurable improvements.
• Ability to interpret and analyze complex data and translate this into meaningful, actionable information for provider groups and/or market leads.
• Skilled at managing multiple projects involving cross-functional teams and maintaining high standards of quality and accuracy.
• This role requires a professional with a blend of technical expertise and strong interpersonal skills to effectively consult and guide provider groups on effective use and interpretation of risk adjustment data and KPIs.
• Advanced skills in Microsoft Office Suite, especially Excel for data handling and analysis, and PowerPoint for presentations.
• Proficiency with Business Intelligence software like Tableau, Power BI to create reports and visualizations.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical benefits
• Dental benefits
• Vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources