Risk Adjustment Data Validation Consultant

  • location: Hopkins, MN
  • type: Contract
  • salary: $26.50 - $40 per hour
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job description

Risk Adjustment Data Validation Consultant

job summary:
Now Hiring: Risk Adjustment Data Validation Consultant

Are you ready for a life-changing opportunity? Are you ready to learn and work with a Top Fortune 500 company? Then embrace this rewarding opportunity NOW!

Apply today because openings are limited!!

Overview

The Risk Adjustment Data Validation Lead/Consultant supports the on-going operations, delivery, and analytics related to data accuracy, quality, submission, remediation, trends and drivers on multiple RADV audits. This role ensures that the data can be effectively used by various operational areas to support their contracted business deliverables.

This position is responsible for performing a wide variety of administrative, analytical and project support duties in a manner which will ensure the productivity and success of the Risk Adjustment Data Validation Audits. The position works under the specific instruction and direction of one or more higher level staff. Incumbents are responsible for professionally and securely handling confidential information while performing several aspects of assigned work.

 
location: Hopkins, Minnesota
job type: Contract
salary: $26.50 - 40.00 per hour
work hours: 9 to 5
education: High School
experience: 4 Years
 
responsibilities:
RESPONSIBILITIES :

The Risk Adjustment Data Validation Consultant/Lead must be able to manage multiple projects, prioritize, effectively communicate and have excellent attention to detail. Incumbent will interface with multiple groups across our client and external vendors to ensure the risk adjustment data validation audit needs are met.

  • Provides assistance with reviewing demographics and eligibility screenshots to ensure accuracy
  • Provides assistance with pulling pharmacy claim screenshots and review to ensure accuracy
  • Provides assistance with the scrubbing of provider demographic information in preparation for vendor medical record retrieval
  • Assist with locating providers where demographic information is missing, incomplete, or locating 'best' provider address (i.e. checking claims source system for alternate provider)
  • Performs follow up on the status of member's health status review from closed/non-closed medical records
  • Timely escalation to leadership of all issues and barriers
  • Prepare and provide weekly member's health status review status reports
  • Demonstrates effective professional verbal and written communication skills in a virtual environment and across time zones
  • Maintains HIPAA standards and confidentiality of protected health information
  • Attend/Participate in meetings
  • Collaborates on and oversees various tasks as assigned that are cross-functional in nature
  • Attend data submission planning meetings with internal source teams and vendors and can be the key point of contact for the correction of data errors should they occur
  • Assist in solving unique and complex problems with broad impact on the business
  • Collaborate with dedicated functional experts to resolve issues quickly and effectively
  • Build and sustain positive relationships with customers through direct and indirect communication
  • Able to accept direction, duties and changing priorities as assigned
 
qualifications:
Required Qualifications:

- 4+ years of Healthcare Industry experience, including claims, membership and/or provider data

- 2+ years Business Analyst experience

- Advanced proficiency with Microsoft Excel

- Self-motivated, highly collaborative, creative, and goal-oriented

- Demonstrated awareness of when to appropriately escalate issues/risks

Preferred Qualifications:

- 2+ years HHS-RADV experience, working knowledge of HHS Risk Adjustment and protocols

- Advanced to intermediate knowledge in other MS Office products

- 2+ years HCC Medical Coding

- Operational/Process management experience

Location: Minnetonka, MN

If you would like to be considered for this opportunity, please apply below.

Amanda Nordmann

amanda.nordmann@randstadusa.com

 
skills: MS Office, Business Analysis, Medical Billing, Health Information, Patient Financial Services, Coding/Batching
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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