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Risk Adjustment Consultant - Medicare, Risk & Analytics- Fastest Growi

Company: Fallon Community Health Plan
Location: Worcester
Posted on: October 10, 2018

Job Description:



Responsibilities: Analyze & Resolve Claims/ Encounter Data Errors

  • Encounter Data/Claims SME
  • Prioritize error resolution
  • Collaborate with internal departments to work toward error resolution
  • Manage Encounter Data softwareProduct Line Support
  • Educate specified product line management on drivers of variances from budget for all revenue streams.
  • Meet regularly with the specified product manager(s) to identify and implement reports to improve revenue optimization efforts.Regulatory Compliance
  • Knowledgeable of data submission timelines and lags - RA factor impact
  • SME for regulatory rate release notes and summaries - review and oversee application of risk adjustment changes specific to Annual Rate Notices and interim rate bulletins from state and federal regulatory agencies.Corporate Project Support
  • Participate in corporate projects and subgroup meetings. Complete analyses related to corporate projects and business needs as required.

    Qualifications:
  • BA or BS - Business Administration, Finance, Economics, Healthcare Administration, other
  • Experience working in Medicare, Medicaid and/or Merged Markets support role: Risk Adjustment, Regulatory, Enrollment, Internal Audit, Accounting, Underwriting, Marketing, Claims - other
  • Proficient/Advanced in Excel
  • Ability to create presentations & exhibits in formats that meet various audience levels
  • SQL- Navigator and/or SAS experience
  • -7 years - Managed Care setting
  • -5 years - Excel
  • -3 years - SQL/SAS Experience

    PM16 4

    Keywords: Fallon Community Health Plan, Worcester , Risk Adjustment Consultant - Medicare, Risk & Analytics- Fastest Growi, Accounting, Auditing , Worcester, Massachusetts

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