Risk Adjustment Consultant

5 days ago

New York, New York, United States CVS Health Full time
Job Summary

The 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 Programs.

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.
Pay Range

The typical pay range for this role is $54,119,300.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

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