Senior Consultant

Company: AArete
Location: Chicago
Posted on: January 28, 2023

Job Description:

Senior ConsultantAArete is one of a kind when it comes to consulting firm culture.As a Senior Consultant, you are analytical, entrepreneurial, and committed to excellence. Your best work is accomplished in a team environment, and you love an exciting challenge. You are described as a high-performing, self-starter, critical thinker with excellent communication skills. You'll have an opportunity to make an impact by solving unique business challenges with the client and internal projects. You will be responsible for driving projects to success and helping to manage a team.In addition, you will support AArete's Revenue Enhancement/Management Solutions as part of our Healthcare Payer practice. Consulting areas include but are not limited to encounter data management and remediation, data reconciliation, performance management, vendor management, risk adjustment forecasting, regulatoryreporting, and premium reconciliation. The candidate will have relevant Risk Adjustment (RA) and encounter management experience as it relates to Medicare Advantage, Medicaid, and/or ACA based programs.Work you'll doConsultant Responsibility

• Define analytic approaches, integrate multiple analyses, and develop an analytic understanding of client problems to identify issues and opportunities to motivate client action
• Gather and refine complex data sets and data sources to enable accurate and robust quantitative analyses
• Create multi-issue client communications, present analytic findings and recommendations, and field client questions with minimal support
• Draw upon healthcare knowledge, trends, and experiences to highlight relevant implications for clients
• Effectively engage with clients, including senior client administrators and physician leads, ensure meaningful results are achieved, and build ongoing relationships
• Proactively work to create an energizing team environment
• Conducts business analysis and recommends solutions to leadershipRevenue Management Responsibility
  • Acts as a lead in various encounter related activities such as data collection, processing, submission, report generation, and reconciliation of encounter records according to State and/or CMS
  • Acts as a lead in various Risk Adjustment activities such as payment and score trending for retrospective and prospective programs
  • Analyze encounter data and conduct root cause analysis
  • Monitors vendor performance and defines optimization strategy for performance improvement, if required
  • Monitors report and communicate on departmental projects to leadership or external business partners
  • Participates in the strategic plans for the risk adjustment and encounter management programs.
  • Engages with leadership on approaches to structure effective risk adjustment initiatives and outcomes
  • Partners with internal and external stakeholders to ensure risk adjustment data is compliant as it relates to regulatory and/or contractual service level agreement (SLA) metrics
  • Serves as a subject matter expert (SME) of Medicare and/or Medicaid risk adjustment encounter requirements, and business processes, including but not limited to regulatory changes impacting the program(s)Requirements
    • Bachelors or Advanced degree in Business Administration, Finance, Statistics, Healthcare Administration
    • 3-5 years' experience working in healthcare industry in Medicaid and/or Medicare Encounter operations, risk adjustment or related operations.
    • Experienced in query design/development (e.g., SAS, SQL, etc.) and/or relational database understanding
    • Knowledge of Medicare and/or Medicaid Encounter Data System and understanding of 837-5010 and/or other standard encounter file formats
    • Experience working with healthcare data specific to risk adjustment and/or related functions
    • Proficient/advanced in MS Office (Excel, PowerPoint, Access, etc.) to derive effective presentations & exhibits for leadership
    • Strong interpersonal, organizational, communication, and workflow skillsPreferred Requirements
      • Experience with risk adjustment encounter file preparation and remediation (e.g.,EDPS 837 5010 files, RAPS returns/submission files, 277CA, and/or 999 file, MAO-002, MAO-004, or EDGE files etc.)
      • Experience with Medicare and/or Medicaid risk adjustment encounter management and reporting from a payer or Risk Adjustment vendor.
      • Knowledge of and experience in Medicare and/or Medicaid risk adjustment functions, regulations, and other related activities
      • Experience with databases as well as interpretation and manipulation of related healthcare data (e.g., claims, enrollment data etc.)
      • Knowledge of encounters within other lines of business, including Exchange/ACA, Medicaid, and/or Medicare Advantage
      • Knowledge of HCC coding, ICD-10, and CPT codesWhy AArete? We are an innovativemanagement and technology consulting firm. In Greek, our name signifies "excellence" - due to this the bar is set high at AArete. We believe that any organization can succeed by enriching and empowering its people - starting with our own team members. Our distinctive Culture of Care compels us to collaboratively solve problems that effect purposeful change for our clients and community.We're growing fast, and you will too. At AArete, we want you to realize your full potential by having direct impact delivering on our mission while prioritizing space for personal development and fulfillment.At AArete, you'll collaborate with team members across the globe. While we have offices in the US, India, and the UK, based on your preference and client needs, AAretians may work on-premises and/or remotely.About AAreteAArete is a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and advisory services. Our cross-industry solutions are powered through modern technology, market intelligence, and big data to drive purposeful change and actionable outcomes.AArete is guided by our deeply embedded principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion. We are proud to have earned a Great Place to Work Certification--- and namedas one of America's Best Management Consulting Firms by Forbes, Vault's Top 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000's Fastest Growing Firms, Consulting Magazine's Fastest Growing Firms. Check out some of our AAwesome Benefits
        • Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays
        • Own Your Day flexible work policy
        • Competitive majority employer paid benefits: Medical, Dental, Vision, 401K Match
        • Employee Stock Ownership Plan
        • Generous maternity / paternity leave options
        • Completely employer paid Life Insurance, STD, LTD
        • Charitable contribution matching program
        • New client commission opportunities and referral bonus program
        • Video free Fridays
        • Bike share discount program
        • Home office allowanceAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Keywords: AArete, Chicago , Senior Consultant, Accounting, Auditing , Chicago, Illinois