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
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