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Risk Adjustment Consulting, Senior at Blue Shield of CA in El Segundo, California

Posted in Other 30+ days ago.

Type: Full Time





Job Description:

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

We seek to add a Risk Adjustment Consulting, Senior to the Medicare Risk Adjustment team.

The Risk Adjustment Consultant provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield/Care1st, working directly with our provider partners, as well as vendors supporting our Risk adjustment program. The ideal candidate possesses excellent customer service skills, project management skills, organizational skill, and high attention to detail. The candidate will also possess a desire and ability to learn specialized healthcare payment expertise.

In order to create an effective team, every individual must have:
Excellent interpersonal/communication skills across various mediums (written, verbally in meetings and over-the-phone).
The ability to drive/engage others outside the team in order to successfully complete projects.
Healthcare background, particularly knowledge of the Medicare Market.
The desire to help our team, Blue Shield/Care1st, and our members.
The ability to manage projects/timelines to achieve successful outcomes.

Responsibilities include:
Assist vendor management efforts around provider outreach engagement and member outreach.
Communication to external parties and/or leadership to present financial/clinical metrics and facilitate their engagement in programs.
Ability to synthesize different pieces of information, and effectively communicate that information.
Develops and produces timely and actionable reporting for internal and/or external use.
Knowledgeable about healthcare-related governmental regulations, procedures, and requirements. Continuous learning as additional information is released.
Ensure complete and accurate submission and tracking of RAPS and EDPS data to regulatory entities.
Maintain tracking reports for claims/encounter data quality.
Create new reports based on input from manager and other stakeholders.
Improve existing processes for efficiency.
Work with cross-functional teams to meet objectives.
Special projects as requested.

We seek to add a Risk Adjustment Consulting, Senior to the Medicare Risk Adjustment team.

The Risk Adjustment Consultant provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield/Care1st, working directly with our provider partners, as well as vendors supporting our Risk adjustment program. The ideal candidate possesses excellent customer service skills, project management skills, organizational skill, and high attention to detail. The candidate will also possess a desire and ability to learn specialized healthcare payment expertise.

In order to create an effective team, every individual must have:
Excellent interpersonal/communication skills across various mediums (written, verbally in meetings and over-the-phone).
The ability to drive/engage others outside the team in order to successfully complete projects.
Healthcare background, particularly knowledge of the Medicare Market.
The desire to help our team, Blue Shield/Care1st, and our members.
The ability to manage projects/timelines to achieve successful outcomes.

Responsibilities include:
Assist vendor management efforts around provider outreach engagement and member outreach.
Communication to external parties and/or leadership to present financial/clinical metrics and facilitate their engagement in programs.
Ability to synthesize different pieces of information, and effectively communicate that information.
Develops and produces timely and actionable reporting for internal and/or external use.
Knowledgeable about healthcare-related governmental regulations, procedures, and requirements. Continuous learning as additional information is released.
Ensure complete and accurate submission and tracking of RAPS and EDPS data to regulatory entities.
Maintain tracking reports for claims/encounter data quality.
Create new reports based on input from manager and other stakeholders.
Improve existing processes for efficiency.
Work with cross-functional teams to meet objectives.
Special projects as requested.

Education/Requirements:

Requires minimum of a bachelors degree in a technical or quantitative field (GPA: 3.0 ) or equivalent combination of experience and education.
Requires a minimum of 5 years of healthcare industry experience.

Excellent interpersonal,

Verbal and written communication and presentation skills especially presentations of complex, technical information to non-technical audiences.
Candidate has had 2 year's experience facilitating meetings and presenting financial/clinical metrics to external parties or internal leadership (Directors and above).

Healthcare background

With a thorough understanding of financial/clinical metrics and claims/encounters.

Candidate has had combined 3 years' experience working in the Risk Adjustment, Medicare Quality/Stars, actuary/underwriting, accounting/finance, provider contracting, provider relations, medical management and/or provider network management areas of a healthcare-related company.

Programming experience
4 years of SAS/SQL or other database programming knowledge, preferred.
5 years of developing analytic reporting. The developed reporting should clearly demonstrate analytic insights into business/financial challenges.

Independent problem solver

Proactive, able to multitask. Patience for working on large scale problems.
Demonstrated ability to work on large scale problems.

Basic proficiency with MS Office.
Proficient in Excel, Word, PowerPoint, and Outlook.

Education/Requirements:

Requires minimum of a bachelors degree in a technical or quantitative field (GPA: 3.0 ) or equivalent combination of experience and education.
Requires a minimum of 5 years of healthcare industry experience.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.