Risk Adjustment Program Consultant

Salary depends on experience
Posted on 05/17/18
5 - 7 years experience
Salary depends on experience
Posted on 05/17/18


This position is responsible for regulatory management and leadership of complex and evolving regulatory activities to support Actuarial operational needs and deliverables; serves as subject matter expert in cross functional teams;

Facilitate and participate in evaluation, development and implementation of new or modified strategies, processes, and operational methods and solutions in relation to business objectives, decisions and statutes, regulations and/or sub-regulatory guidance requirements.


* Bachelor degree and 5 years of experience in business; or 9 years’ experience in related field.
* 3 years of regulatory experience.
* Experience providing support to senior staff in process re-engineering and strategic problem-solving.
* Experience conducting analyses and developing, executing and communicating strategic and operational impacts.
* Creative thinking skills.
* Experience providing strategic and tactical direction based on quantitative and qualitative analyses.
* Knowledge of the regulatory process and health care industry business requirements, processes, functions and drivers.
* Experience communicating and providing support to senior level staff in process re-engineering and strategic problem-solving.
* Knowledge of enterprise business operations.
* Experience managing multiple projects and project teams.
* Effective skills in both verbal and written communication, including facilitation and presentations.
* Effective interpersonal skills.
* Strong organizational skills and detail oriented.
* Problem resolution experience and skills dealing with internal and external customer needs.
* Handle and manage multiple tasks and projects simultaneously.
* Experience working independently and responding to rapidly changing priorities to achieve goals and objectives in a timely manner.
* Skills to operate in cross-functional teams.
* PC proficiency to include Microsoft Word, Excel and PowerPoint.


* Working knowledge of business process model and organizational functions.
* Working knowledge of the Affordable Care Act and Reinsurance and Commercial and Medicare Risk Adjustment programs.
* Understand impact of CMS Risk Adjustment RAPS, EDPS and EDGE server submissions
* Strong Data Management Skills
* Intermediate knowledge of Excel ad Access Databases
* Ability to manage multiple data sources, provider groups and vendors
* Ability to coordinate between multiple internal and external business partners.

Job ID: DLP-1024964



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