Medicare Risk Adjustment Business Information Consultant Sr

Anticipated End Date:

2025-05-23

Position Title:

Medicare Risk Adjustment Business Information Consultant Sr

Job Description:

Location: 

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.

Hours: Monday - Friday

Position Overview:

Responsible for coordinating and consolidating various impact analyses for management reporting.

How You Will Make an Impact:

• Conduct comprehensive research and analysis to identify trends, areas for improvement, and opportunities within Medicare markets ad 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.

• Serves as a strategic partner to the business and contributes to ideas and solutions

• Influences others and works effectively to establish and develop working relationships both internally and externally with business stakeholders

• Serves as a subject matter expert on Risk Adjustment programs and risk adjustment payment methodology

• Leads and consults with operations on ad hoc requests/special projects

Required Qualifications:

• 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.

Preferred Qualifications:

• 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

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

RDA > Business/Health Info

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and