Medicare Advantage Risk Adjustment Performance Improvement Consultant

University of California - Los Angeles Health
United States, California, Los Angeles
Nov 18, 2024
Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: Serving as a Subject Matter Expert (SME) for risk adjustment with contracted IPAs Collaborating with IPAs on risk adjustment strategies to achieve health plan goals and KPIs Presenting and managing all risk adjustment programs offered by the health plan Act as a consultant and partner to the contracted IPAs Traveling to contracted IPAs within the Los Angeles County area Salary Range: $76,200 - $158,800 Qualifications We're seeking a self-motivated, detail-oriented individual with: A Bachelor's degree in Health Care Administration, Public Health, Population Health, Finance, Business Analytics or related field and/or equivalent experience Project Management (PMP) Certification, a plus Five or more years of experience in healthcare analytics, strategy, and/or consulting at an IPA or health plan level, required Three or more years of health plan experience, highly desired Three or more years of recent experience in risk adjustment, required Strong understanding of risk adjustment operations and V28 payment model and condition categories Project management and program management experience Knowledge of HIPAA regulations Knowledge of Medicare Advantage, STARS/HEDIS program, and NCQA technical specifications, a plus Knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS, a plus Excellent interpersonal skills to build relationships with clinical and non-clinical personnel Strong analytical and creative problem-solving skills Proficient in Microsoft Word, Excel, PowerPoint, and Outlook Reliable transportation to travel to and from contracted IPAs in Los Angeles County, required