Revenue Integrity Operations Consultant

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

About AmeriHealth Caritas

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com .

Role Overview

Under the general direction of the Vice President, Health Markets Strategy & Planning, the Revenue Integrity Ops Consultant is responsible for managing all aspects of risk adjustment and benefit conversion activity-related intervention operations. The Revenue Integrity Ops Consultant will serve as the point of contact for all lines of business and responsibilities.

Work Arrangement

• Remote within the United States

Responsibilities

• Responsible for managing all member and provider-facing risk adjustment and benefit conversion-related intervention activities (including related vendors), working directly with each health plan to ensure market nuance is considered in the implementation and execution of all risk adjustment and benefit conversion-related activities.

• Responsible for Interfacing with all analytical teams related to risk adjustment and benefit conversion activities.

• Maintain a strong relationship with key risk adjustment and benefit conversion stakeholders from all health plan(s) (e.g., Provider Network Management Account Executives, Quality and HEDIS leaders, etc.). This includes, but not limited to: weekly communications with program status, distribution of reports, monthly meetings, being a point of contact for issues and questions.

• Facilitate review and approval of program collaterals/communications for both implementation of new program components or to support ongoing needs of the program.

• Generate and monitor meaningful performance and financial metrics to evaluate performance of each line of business. Report timely and accurate information to management through standardized dashboards and reports. Broadcast results of reporting to stakeholders and ensure that any data anomalies or areas of concern are called to audience.

• Partner with internal stakeholders to develop, govern, and optimize standardized reporting processes and tools that assist in advancing Revenue Integrity and Risk Adjustment performance to align with organizational objectives.

• Analyze data to identify areas for targeted campaigns to increase chronic diagnosis capture.

• Serve as POC for provider portal(s) and other vendor applications used that support the risk adjustment program.

• Track, research and resolve issues reported to risk adjustment from a myriad of sources (e.g., providers, Account Executives, leadership, etc.). Escalate issues to management for assistance in resolution.

• Progress and resolution are communicated frequently with stakeholders.

• Complete assigned analysis of data to identify areas for targeted campaigns to increase chronic diagnosis capture.

• Identify goals and targets, create and execute project plans to achieve desired outcomes.

• Participate in the development of protocols, procedures and operational strategies to modify existing or implement new processes or programs and act as a mentor for other team members, working with them to develop business knowledge, analytical skills and basic technical abilities.

• Act as Subject Matter Expert for all assigned markets, vendor activities, risk adjustment models (e.g., HCC, CDPS+RX, ACG, etc.) and concepts, as well as other health insurance data sets available to support the program.

Education/Experience

• Bachelor's Degree or combination of education and experience.

• Minimum 7+ years of analytic experience with a concentration in business or data analysis for Medicare/Medicaid Risk Adjustment, and/or benefit conversion-related programs.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.