Risk Adjustment Consultant

Point32Health • Canton, MA

6d • $85,666 - $128,498 • Remote

About The Position

Under the supervision of the Manager of Risk Adjustment Strategy & Operations, this individual will support the operations and analysis of all risk adjustment programs and serve as the primary point of contact to a select portion of our provider network. This includes strategically important business partners, such as integrated delivery networks, large facilities and/or physician organizations. This individual will also work closely with internal departments and external vendors to ensure that risk adjustment programs are implemented and operated at the highest levels of performance. The Risk Adjustment Consultant will also work closely with our Network Contracting, Clinical and Care Management departments to deliver timely reporting and performance management advisory services to our provider network. This individual regularly demonstrates self-direction and motivation toward completion of on-going department initiatives.

Requirements

• Bachelor's degree required, preferably in related field. Graduate degree preferred.
• Three to five years of experience in a progressively responsible role with stakeholder management experience in a complex operational setting or consulting role.
• Highly energetic, organized, detail-oriented, resourceful and self-motivated
• Highly proficient in Microsoft Excel, PowerPoint and Word; additional database systems a plus
• Excellent interpersonal and communication skills
• Ability to work collaboratively with both internal and external resources
• Ability to develop professional and effective relationships as a strategic advisor to our provider network
• Ability to take responsibility, prioritize tasks and follow through to completion
• Ability to organize, manage, and analyze large sets of data
• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Nice To Haves

• Previous experience working in strategy implementation, analytical and process improvement in the health care / health insurance sector either for a health plan, provider group or management consultancy is a plus.
• Understanding of US Health Policy and experience working with CMS, health insurers and medical providers highly desired.

Responsibilities

• Provider Engagement Develop and maintain strong and effective working relationships with key business and medical leaders at provider organizations within our network Coordinate and facilitate regularly scheduled and ad hoc provider meetings to provide operational updates, discuss strategic initiatives and improvement opportunities Work collaboratively with risk adjustment provider educators and the quality assurance team to focus the provider training and education specifically related to coding accuracy and documentation to high impact providers
• Data Analysis Support the evaluation of medical group opportunities and challenges specific to risk adjustment performance, identify and/or modify training needs and/or programmatic interventions to improve performance and refine the engagement plans Analyze, interpret and synthesize medical group specific results and risk score trend information; deliver the results of standard and ad hoc analyses to improve awareness and understanding of risk scores and the quality, accuracy and identification of member health conditions Perform high level financial analysis on risk adjustment programs to evaluate and report financial impact to provider organizations
• Risk Score Reporting Build and refine medical group specific profiles including but not limited to governance, financials, risk scores, resources, and technology Manage provider outreach and ongoing communications/reporting for all risk adjustment programs and initiatives. Serve as the risk adjustment subject matter expert to address provider concerns and assist them in understanding the complexities of risk adjustment programs and the resulting data
• Collaboration with Internal Stakeholders and External Vendors Develop effective and positive working relationships with internal partners (Network Contracting, Clinical Services, Provider Performance Management, Actuarial, etc.) to collaborate on provider engagement and performance improvement initiatives Collaborate and coordinate with internal partners to conduct comprehensive analysis and deliver professional presentations to our provider network at shared meetings Manage multi-faceted vendor initiatives to ensure smooth implementation and operations Support the Risk Adjustment department in efforts to assess additional diagnosis coding opportunities that can be procured or potentially developed internally
• Administration Attend provider engagement meetings, document provider concerns and key decisions, and manage follow up actions as necessary Stay informed about CMS and industry trends and best practices; utilize this knowledge to recommend modifications to Point32Health’s risk adjustment programs and provider engagement practices Support the development and refinement of key deliverables to our provider community, including presentations, reference material and communications Other duties and projects as assigned.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees