One of the leading health insurers in California is looking to bring on a Risk Adjustment Consultant to provide expertise in risk adjustment for their providers.
The Risk Adjustment Consultant will be responsible for:
- Consulting with Provider Groups to drive improvements in support of their risk adjustment processes
- Assisting Provider Groups in understanding the CMS-HCC Risk Adjustment as it relates to payment methodology through their claims/encounter submissions
- Assisting Provider Groups in understanding Medicare Stars quality and incentive programs utilizing analytics and identifies and target providers.
- Work with Provider Group operational and clinical leadership to assist in identification of operational and clinical practices in maximizing recapture rates, understanding clinical suspects, and monitoring of appropriate clinical documentation and accurate coding.
The Risk Adjustment Consultant should have the following qualifications:
- Minimum of 6 to 7 years of professional experience.
- Bachelor's degree in Healthcare Administration, Business Administration, Master's Degree
- Requires healthcare industry experience, preferably with the Medicare market
- Knowledge of ICD-10, Risk Adjustment, ICD-10, Medicare Quality/Stars, analytics/finance, provider contracting, provider relations, medical management and/or provider network management areas of a healthcare-related company.
- Experience developing analytic reporting analytic insights
