Current jobs related to Risk Adjustment Consultant - New York, New York - CVS Health
-
Risk Adjustment Consultant
2 months ago
New York, New York, United States CVS Health Full timeJob SummaryThe Manager, Business Consultation role at CVS Health is a critical position that requires a high degree of expertise in Risk Adjustment payment models for Medicare Advantage, ACA, and Medicaid. The successful candidate will be responsible for monitoring and managing day-to-day operations for Commercial Accountable Care Act (ACA) Prospective...
-
Risk Adjustment Consultant
1 day ago
New York, New York, United States CVS Health Full timeAt CVS Health, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose drives our commitment to make healthcare more personal, convenient, and affordable. As a Manager in our Business Consultation team, you'll play a critical role in transforming our culture and accelerating innovation. The Manager, Business...
-
Actuary, Risk Adjustment
4 weeks ago
New York, New York, United States Oscar Health Full timeAbout the RoleOscar Health is seeking an experienced Actuary, Risk Adjustment to join our Actuarial team. As a key member of our team, you will play a critical role in supporting our valuation, risk adjustment, forecasting, strategy, and pricing processes for several Affordable Care Act (ACA) markets.You will be responsible for reviewing pricing,...
-
Risk Adjustment-Claims Specialist
2 weeks ago
New York, New York, United States CVS Health Full timeJob SummaryCVS Health is seeking a highly skilled and experienced professional to join our team as a Manager, Business Consultation. This role will be responsible for monitoring and managing day-to-day operations for Commercial Accountable Care Act (ACA) Prospective Programs.Key ResponsibilitiesAssist in managing the day-to-day complex business consultation...
-
Senior Risk Adjustment Coder Specialist
1 week ago
New York, New York, United States Oscar Health Full timeAbout the RoleOscar Health is seeking a highly skilled Senior Risk Adjustment Coder Specialist to join our Risk Adjustment team. As a key member of our team, you will be responsible for daily operations related to Risk Adjustment, including medical record reviews, potential CMS audits, and medical record retrieval efforts.Key responsibilities include...
-
New York, New York, United States VNS Health Full timeJob SummaryAs a Senior Manager of Statistical Analysis and Risk Adjustment, you will lead the development and implementation of comprehensive risk adjustment analytics strategies, leveraging business intelligence reporting, financial forecasting, and ROI analysis to inform decision-making. This role requires a strong understanding of risk adjustment...
-
Healthcare Professional
7 days ago
New York, New York, United States Hueman Risk Adjustment Full timeJob OpportunityHueman Risk Adjustment is seeking qualified Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in the New York City area. This unique opportunity offers a flexible schedule, allowing you to balance your professional goals with your personal preferences. Whether...
-
Risk Consultant
3 weeks ago
New York, New York, United States AXA XL Ltd Full timeJob Title: Risk ConsultantWe are seeking a highly skilled Risk Consultant to join our Loss Prevention Education Programs Department. As a Risk Consultant, you will play a critical role in helping our clients grow by addressing their needs at the intersection of strategy, technology, marketing, and innovation.Key Responsibilities:Develop new educational...
-
Risk Management Consultant
4 days ago
New York, New York, United States AXA XL Ltd Full timeJob Title: Risk Management ConsultantAbout the Role:We are seeking a highly motivated and experienced Risk Management Consultant to join our team at AXA XL Ltd. As a Risk Management Consultant, you will play a key role in helping our clients manage and mitigate risks associated with their business operations.Key Responsibilities:Develop and implement risk...
-
IT Risk Consultant
7 days ago
New York, New York, United States ScaleneWorks People Solutions LLP Full timeJob Role: We are seeking a highly experienced IT Risk Consultant to assist us with the next phase of our assessment of IT risks at the U.S. division of a larger international bank.Key Responsibilities: Evaluate design, development, and acquisition practices and governance frameworks to ensure alignment with industry practice and applicable regulatory...
-
Risk Engineering Consultant
3 weeks ago
New York, New York, United States Zurich Insurance Company Full timeJob Title: Property and Casualty Risk Engineering ConsultantZurich's Northeast Middle Markets Risk Engineering team is seeking a Risk Engineering Consultant with multi-line Risk Engineering experience to support the Middle Markets Underwriting Business Unit. This is a work-from-home role ideally positioned in the Long Island, NY, New York City, or...
-
Risk Management Consultant
4 weeks ago
New York, New York, United States Global Business Consulting Services (GBCS) Full timeJob Title: RCSA and Key Risk Indicator Reporting ConsultantGlobal Business Consulting Services (GBCS) is seeking a highly skilled RCSA and Key Risk Indicator Reporting Consultant to join our team.Job Summary:We are looking for a seasoned risk management professional with expertise in RCSA and Key Risk Indicator reporting to join our team. The successful...
-
Senior Risk Consultant
3 weeks ago
New York, New York, United States HUB International Full timeAbout HUB InternationalHUB International is a global firm that empowers its clients by protecting businesses and individuals in local communities. We help businesses evaluate their risks and develop tailored solutions. Our structure enables teams to maintain a unique regional culture while leveraging corporate resources.About the PositionThe Senior Risk...
-
Risk Management Consultant
2 weeks ago
New York, New York, United States Control Risks Full timeJob SummaryWe are seeking a highly skilled and experienced Risk Management Consultant to join our team at Control Risks. As a key member of our crisis, security, and cyber consulting teams, you will be responsible for supporting clients and other team members across a broad range of risk management projects.Your primary focus will be on business continuity,...
-
Risk Engineering Consultant
1 week ago
New York, New York, United States Zurich Insurance Company Full timeJob SummaryZurich's Northeast Middle Markets Risk Engineering team is seeking a Risk Engineering Consultant to support the Middle Markets Underwriting Business Unit. This is a work-from-home role ideally positioned in the Long Island, NY, New York City, or Westchester, NY area. The successful candidate will have a company car and will be expected to travel...
-
Risk Control Consultant
4 days ago
New York, New York, United States Alliant Insurance Services Full timeJob SummaryWe are seeking a highly skilled Risk Control Consultant to join our team at Alliant Insurance Services. As a Risk Control Consultant, you will be responsible for conducting on-site technical risk assessments for external clients to assist in complying with safety legislation and industry practices.Key ResponsibilitiesConduct on-site technical risk...
-
Risk Engineering Consultant
1 month ago
New York, New York, United States Zurich Insurance Company Full timeJob Title: Property and Casualty Risk Engineering ConsultantZurich's Northeast Middle Markets Risk Engineering team is seeking a skilled Risk Engineering Consultant to support the Middle Markets Underwriting Business Unit. This role is ideal for individuals with multi-line Risk Engineering experience and a strong understanding of risk assessment and...
-
Risk Management Consultant
4 days ago
New York, New York, United States AXA XL Ltd Full timeRisk Management ConsultantAXA XL Ltd is seeking a skilled Risk Management Consultant to join our Loss Prevention Education Programs Department. As a key member of our team, you will be responsible for developing and delivering value-added educational programs and content to help customers reduce their incidence of loss. Key Responsibilities:Develop new...
-
Nurse Practitioner or Physician Assistant
7 days ago
New York, New York, United States Hueman Risk Adjustment Solutions Full timeJoin Our Team of Healthcare ProfessionalsHueman Risk Adjustment Solutions is actively seeking qualified Nurse Practitioners and Physician Assistants to join our team as part-time Health Risk Assessors (HRAs) in Central Square, NY.This unique opportunity allows you to work on your own terms, with a flexible schedule designed to meet your needs. As an HRA, you...
-
Healthcare Professional
4 days ago
New York, New York, United States Hueman Risk Adjustment Solutions Full timeJoin Our Team of Healthcare ProfessionalsHueman Risk Adjustment Solutions is actively seeking qualified Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in the Amsterdam, NY area.This unique opportunity offers a flexible schedule, allowing you to achieve your professional goals...
Risk Adjustment Consultant
2 months ago
About the Role
The Manager, Business Consultation position at CVS Health is a critical role that requires a strong understanding of commercial accountable care act (ACA) prospective programs. As a key member of our team, you will be responsible for monitoring and managing day-to-day operations, ensuring timely reconciliation of claims for encounter submission deadlines, and meeting the needs of revenue integrity's internal market and product customers.
Key Responsibilities
- Assist in managing the day-to-day complex business consultation services to support the organization's goals and objectives.
- Implement processes and assignments for research, collecting, analyzing, and compiling data and information for the business consulting department reports.
- Assess files, reports, and financial records, and manage department record retention.
- Direct individuals to develop a high degree of customer service by fielding internal and external inquiries, finding resolutions, or redirecting as appropriate.
- Confer internally and externally with clients and senior management regarding the organization's goals and objectives.
- Coach the internal and external department point of contact ensuring concise communication with employees, stakeholders, and members of the senior management.
- Deliver advice to the organization regarding current business trends and best practices by preparing analyses for senior management, stakeholders, and clients.
- Implement processes to performance appraisals within the business consulting department ensuring compliance and continuous improvement.
- Help establish and implement strategic review processes ensuring continuous improvement, compliance, and high-performance standards are upheld.
Requirements
- A minimum of 5 years expertise in risk adjustment payment models for Medicare Advantage, ACA, and Medicaid.
- Expertise in risk adjustment timelines and requirements.
- Prefer colleague has some experience in query tools such as SQL, SAS, Python, R+.
- Certified coding certification such as CPC-P, CRC, or AHIMA is preferred.
Education
- Bachelor's Degree or equivalent combination of education and experience.
