Remote Risk Adjustment Consultant

  • location: Hopkins, MN
  • type: Contract
  • salary: $41.33 per hour
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job description

Remote Risk Adjustment Consultant

job summary:
Our Client is Hiring!

Please Note: This is 100% remote, the preferred location is MN but open to anywhere in the US if experience qualifies

Job Description:

The Risk Adjustment Data Validation 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.

Primary Responsibilities:

  • 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
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: Hopkins, Minnesota
job type: Contract
work hours: 8 to 5
education: Bachelor's degree
experience: 4 Years
 
responsibilities:
1. Provides assistance with reviewing demographics and eligibility screenshots to ensure accuracy

2. Provides assistance with pulling pharmacy claim screenshots and review to ensure accuracy

3. Provides assistance with the scrubbing of provider demographic information in preparation for vendor medical record retrieval

4. Assist with locating providers where demographic information is missing, incomplete, or locating 'best' provider address (i.e. checking claims source system for alternate provider)

5. Performs follow up on the status of member's health status review from closed/non-closed medical records

6. Timely escalation to leadership of all issues and barriers

7. Prepare and provide weekly member's health status review status reports

8. Demonstrates effective professional verbal and written communication skills in a virtual environment and across time zones

9. Maintains HIPAA standards and confidentiality of protected health information

10. Attend/Participate in meetings

11. Collaborates on and oversees various tasks as assigned that are cross-functional in nature

12. 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

13. Assist in solving unique and complex problems with broad impact on the business

14. Collaborate with dedicated functional experts to resolve issues quickly and effectively

15. Build and sustain positive relationships with customers through direct and indirect communication

16. 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

 
skills: Business Analysis
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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