Current jobs related to Risk Adjustment Consulting, Consultant - Oakland - Blue Shield of California

  • Principal Compliance

    4 weeks ago

    Oakland, United States PG&E Full time

    Bay Area Minimum: $132,000.00-Bay Area Maximum: $226,000.00 United States, California, Oakland Aug 23, 2024 Requisition ID# 158553 Job Category: Compliance / Risk / Quality Assurance Job Level: Manager/Principal Business Unit: Information Technology Work Type: Hybrid Job Location: Oakland Department Overview Enterprise Protection-Information Technology...

  • Lead Consultant, Risk and Compliance Management

    4 weeks ago

    Oakland, California, United States PG&E Corporation Full time

    Requisition ID # Job Category: Government and Regulatory Relations Job Level: Senior Manager Business Unit: Information Technology Work Type: Hybrid Job Location: Oakland Department Overview The Enterprise Protection-Information Technology (EP-IT) Governance, Risk and Compliance (GR&C) team is tasked with overseeing risk management and...

  • Director of Risk Adjustment Compliance

    2 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Job SummaryThe Director of Risk Adjustment Compliance will oversee and maintain a high-quality, effective, best practices risk adjustment compliance program to prevent and detect violations of law and other misconduct and to promote ethical practices and a commitment to compliance with applicable federal, state, and local laws, rules, regulations, and...

  • Principal Compliance

    4 days ago

    OAKLAND, United States PG&E Corporation Full time

    Requisition ID # 160511 Job Category: Compliance / Risk / Quality Assurance Job Level: Manager/PrincipalBusiness Unit: Gen Counsel, Ethics, Risk & ComplianceWork Type: HybridJob Location: Oakland  Department OverviewThe employees of the Enterprise NERC Compliance (ENC) team ensure the delivery of safe and reliable electric service to our customers...

  • Director, Risk Adjustment Compliance Specialist

    3 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Job Summary:The primary purpose of the Director, Risk Adjustment Compliance is to provide oversight and maintenance of a high-quality, effective, best practices risk adjustment compliance program to prevent and detect violations of law and other misconduct and to promote ethical practices and a commitment to compliance with applicable federal, state, and...

  • Director of Risk Adjustment and Compliance

    5 days ago

    Oakland, California, United States Altais Health Solutions Full time

    About the RoleWe are seeking a highly skilled and experienced Director of Risk Adjustment and Compliance to join our team at Altais Health Solutions. As a key member of our organization, you will be responsible for ensuring the accuracy and completeness of our risk adjustment and HEDIS/STARS data.Key ResponsibilitiesDevelop and implement comprehensive risk...

  • Senior Director of Compliance for Risk Adjustment

    4 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Position Overview: The Director of Compliance in Risk Adjustment is responsible for overseeing and enhancing a robust compliance framework that adheres to best practices in risk adjustment. This role is pivotal in ensuring adherence to federal, state, and local regulations while fostering ethical conduct within the organization. The Director will guide the...

  • Consultant IV

    4 weeks ago

    Oakland, United States Kaiser Permanente Full time

    The Medi-Cal Portfolio Administration and Governance team works with Executives, Leaders, and teams across the organization to ensure traceability, accountability, and appropriate escalation of key issues and decisions in order to achieve business objectives. The Portfolio Administration and Governance team ensures the structure and processes are in place to...

  • Senior Director of Compliance in Risk Adjustment

    4 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Position Overview: The Director of Compliance for Risk Adjustment is responsible for the strategic oversight and enhancement of a robust compliance program focused on risk adjustment practices. This role is essential in ensuring adherence to federal, state, and local regulations while fostering a culture of ethical conduct and compliance within the...

  • Nurse Practitioner

    3 days ago

    Oakland, California, United States Hueman Risk Adjustment Full time

    Job OpportunityHueman Risk Adjustment is seeking a skilled Nurse Practitioner to join our team in providing in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in the Oakland, CA area.This unique opportunity offers a flexible schedule, allowing you to balance your professional goals with your personal preferences. As a Nurse...

  • Nurse Practitioner

    3 days ago

    Oakland, Maryland, United States Hueman Risk Adjustment Full time

    Job OpportunityHueman Risk Adjustment is seeking a skilled Nurse Practitioner to join our team in providing in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in the Oakland, MD area.This unique opportunity offers a flexible schedule, allowing you to balance your professional goals with your personal preferences. As a Nurse...

  • Head of Risk Adjustment Compliance Strategy

    4 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Position Overview: The Director of Compliance for Risk Adjustment is responsible for the strategic oversight and enhancement of a robust compliance program aimed at ensuring adherence to legal standards and ethical practices within the realm of risk adjustment. This role is pivotal in steering the compliance initiatives across various risk adjustment...

  • Construction Consulting Associate

    18 hours ago

    Oakland, California, United States Exponent Full time

    About ExponentExponent is a leading engineering and scientific consulting firm that provides expert solutions to complex challenges. Our team of multidisciplinary experts works together to deliver innovative and effective solutions that create a safer, healthier, and more sustainable world.Job SummaryWe are seeking a highly skilled Construction Consulting...

  • Business Consultant IV

    2 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Job SummaryServes as a strategic advisor to drive the implementation of successful business initiatives and projects across diverse stakeholders. Provides expert insight and supports the development and implementation of business strategies, systems, and processes to achieve a desired future state.Key ResponsibilitiesPromotes learning and development among...

  • Environmental Consultant

    4 weeks ago

    Oakland, California, United States Exponent Full time

    About Exponent:Exponent stands as a premier engineering and scientific consulting firm, equipped with extensive expertise to address our clients' most unique and urgent challenges.Our mission is to assemble multidisciplinary teams of scientific, engineering, and regulatory specialists to provide clients with solutions that foster a safer, healthier, and more...

  • Construction Consulting Associate

    2 weeks ago

    Oakland, California, United States Exponent Full time

    About ExponentExponent is a leading engineering and scientific consulting firm that empowers clients to solve complex challenges. Our multidisciplinary teams of experts collaborate to deliver innovative solutions that create a safer, healthier, and more sustainable world.Our OpportunityWe are seeking a Construction Consulting Associate to join our...

  • Senior Coding Analyst, Risk Adjustment Specialist

    14 hours ago

    Oakland, California, United States Altais Full time

    Job Title: Senior Coding Analyst, Risk AdjustmentAbout the Role:We are seeking a highly skilled Senior Coding Analyst, Risk Adjustment to join our team at Altais. As a key member of our Clinical Performance team, you will be responsible for coding medical records for HCC reimbursement, training, education, and compliance. Your expertise will play a critical...

  • Senior Manager

    3 days ago

    Oakland, California, United States Exponent Full time

    About ExponentWe are a premier engineering and scientific consulting firm with a unique blend of expertise to tackle complex challenges. Our multidisciplinary teams of science, engineering, and regulatory experts empower clients with innovative solutions for a safer, healthier, and more sustainable world.Our OpportunityWe are seeking a Senior Manager to lead...

  • Nurse Practitioner or Physician Assistant

    6 hours ago

    Oakland, Maine, United States Hueman Risk Adjustment Full time

    Job OpportunityHueman Risk Adjustment is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Oakland, ME.This unique opportunity offers a flexible schedule, allowing you to achieve your professional goals on your terms. Whether you're seeking...

  • Strategic Business Consultant

    3 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Job Summary:Serves as a strategic business consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects. Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state.Key...

Risk Adjustment Consulting, Consultant

4 months ago

Oakland, United States Blue Shield of California Full time

Your Role

 

The Blue Shield’s Risk Adjustment (RA) team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us to deliver industry-leading results. The RA team is looking to improve operational coordination with our providers to more effectively retrieve medical records. This role is highly collaborative and requires the ability to understand and coordinate operations across multiple providers and health insurer areas.

 

The Chart Retrieval, Risk Adjustment Consultant will report to the Manager of Medicare Chart Program. In this role you will play a critical role in expanding Blue Shield’s medical records retrieval initiatives, ensuring accuracy and timeliness for both our ACA and Medicare teams.

 

Your Work

 

In this role, you will:

  • Make recommendations based on understanding the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods
  • Train lower-level analysts on how to update and apply these advanced analytic techniques 
  • Drive leadership, guidance, and manage all aspects of a given program, including vendor oversight, internal cross-functional partnerships, tracking performance and measuring results
  • Manage data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals 
  • Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
  • Collaborate with healthcare providers and vendors to efficiently acquire medical records, particularly with non-responsive providers and charts showing as not available in providers’ Electronic Medical Records systems
  • Collaborate closely with ACA Retrospective Risk Adjustment Team and Medicare Retrospective Risk Adjustment Team to improve medical records retrieval
  • Utilize strong communication skills to liaise with internal and external stakeholders
  • Maintain a meticulous and organized approach to ensure accurate record retrieval through grouping charts by custodians per rosters and instructions from providers
  • Proactively identify and implement improvements to optimize the retrieval process

 

Your Knowledge and Experience

 

  • Requires a bachelor’s degree or equivalent experience
  • Requires at least 6 years of professional experience
  • Requires at least 4 years of Risk Adjustment, medical records retrieval, or a related field
  • Requires excellent written and spoken communication skills of technical material to executive leadership and interpersonal skills
  • Requires strong organization skills and a keen eye for detail
  • Requires the ability to work independently and as part of a team


Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

Pay Range:

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.