Career Center
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Fresno, California
Posted: 23-Jan-25
Location: Los Angeles, California
Internal Number: 145884515
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
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
