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Manager, Business Consultant
2 months ago
Position Summary:
As a Manager, Business Consultant within the Revenue Integrity organization, you will be leading Risk Adjustment technical activities, not limited to electronic medical record data extraction, reconciliation and aggregation, and financial and operational reporting.
Fundamental Components:
Responsible for providing guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to support ACA IFP Risk Adjustment Revenue Integrity initiatives. Responsible for leading the reconciliation of data (coding review results and medical record images) from different sources, identifying gaps within the process, and leading to develop more efficiency within the process. Act as business lead for system design and in testing new functions, as well as, the support of auditing activities related to vendor reconciliation of coding results and medical record images as well as other technical projects. Drive change related to enhancements and system fixes. Understanding interdependencies both process wise and timing wise, to further business objectives. To be successful, the candidate will use their knowledge and experience to create meaning from the data. This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place. You will be responsible for auditing tasks including documenting and evaluating critical controls. You will be responsible for understanding procedures, results and business impacts; and document and express such understanding in both written and verbal form. Conducts periodic updates of analytical routines and department production systems. Investigates and evaluates alternative solutions to meeting business needs.
Required Qualifications:
Experience with IT application development lifecycles, methodologies.
Experience with SAS/SAS EG/Python/SQL server in data analytics and manipulation.
Experience with BI tools, including Tableau, Quicksight, PowerBI.
Vendor management experience.
Experience with CMS Risk Adjustment programs.
5+ years of healthcare, health insurance, or relevant combination of experience.
5+ years of experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis strategic business planning, and/or risk management consulting.
Preferred Qualifications:
Experience documenting business processes, as well as, recommending and implementing improvement strategies.
Participates in system design.
Strong problem-solving, analytical, critical thinking and project management skills.
Experience influencing others by turning data into meaningful and actionable information.
Ability to perform testing functions.
Ability to audit the accuracy of reporting against source documents/reports/databases.
Ability to implement auditing procedures.
Attention to detail.
Strong negotiation skills.
Education
Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline or equivalent professional work experience.
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