Risk Adjustment Consultant -- Remote | WFH

About Us

We are a leading health and wellbeing organization committed to providing personalized healthcare experiences to our communities. At our organization, we build on the quality and nonprofit heritage of our founding partners, prioritizing the health and wellbeing of individuals.

Job Summary

Reporting to the Senior Manager of Provider Consulting & Operations, you will play a vital role in supporting the operations and analysis of our risk adjustment programs. As a Risk Adjustment Consultant, you will serve as the primary point of contact for a select portion of our provider network, including key business partners such as integrated delivery networks and physician organizations. You will collaborate with internal departments and external vendors to ensure the success of our risk adjustment programs and provide essential support to our provider network.

Key Responsibilities/Duties

Provider Engagement:

• Foster strong relationships with key leaders at provider organizations within our network.
• Coordinate regular and ad hoc provider meetings to provide updates and discuss strategic initiatives.
• Collaborate with internal teams to deliver training and education on coding accuracy and documentation.
  
  

Data Analysis

• Evaluate medical group opportunities and challenges related to risk adjustment performance.
• Analyze and interpret medical group-specific results and risk score trends.
• Conduct financial analysis on risk adjustment programs and report findings to provider organizations.
  
  

Risk Score Reporting

• Develop and refine medical group profiles.
• Manage provider outreach and communications for risk adjustment programs.
• Collaborate with internal stakeholders and external vendors to improve program effectiveness.
  
  

Collaboration And Administration

• Build positive working relationships with internal partners.
• Attend provider engagement meetings and manage follow-up actions.
• Stay informed about industry trends and best practices.
  
  

Qualifications

Education, Certification, and Licensure:

• Bachelor's degree required, preferably in a related field. Graduate degree preferred.
  
  

Experience

• Three to five years of experience in stakeholder management or consulting.
• Previous experience in healthcare or health insurance preferred.
  
  

Skills

• Highly organized and self-motivated.
• Proficient in Microsoft Excel, PowerPoint, and Word.
• Excellent interpersonal and communication skills.
• Ability to analyze large sets of data.
  
  

Working Conditions And Additional Requirements

• Must be able to work under normal office conditions and from home as required.
• May be required to work additional hours beyond the standard schedule.
  
  

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity:

We are committed to fostering diversity, equity, inclusion, accessibility, and health equity in everything we do. We welcome applicants from all backgrounds and ensure fair consideration for employment. Our commitment to diversity is integral to our core values.

Employment Type: Full-Time