Risk Adjustment Consulting, Senior - El Dorado Hills , California, United States, 95762

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.


This position is within the Medicare Risk Adjustment team within the Actuarial Department and will be part of a small team ensuring accurate and quality data is submitted to CMS. The Risk Adjustment Analyst will provide essential support to all functions within the Medicare Risk Adjustment team, which includes interaction with various cross-functional teams within Blue Shield/Care1st, as well as vendors supporting our Risk Adjustment team. The ideal candidate possesses excellent customer service skills, project management skills, organizational skill, and high attention to detail. The candidate will also possess a desire and ability to learn specialized healthcare payment expertise.

To create an effective team, every individual must have
• Excellent interpersonal/communication skills across various mediums (written, verbally in meetings and over-the-phone).
• The ability to drive/engage others outside the team to successfully complete projects.
• Healthcare background, particularly knowledge of the Medicare Market.
• The desire to help our team, Blue Shield/Care1st, and our members.
• The ability to manage projects/timelines to achieve successful outcomes.

• Ensure end-to-end reconciliation of claims and encounter data.
• Works internally across different departments, including IT, claims, and membership, to resolve data quality gaps.
• Works externally with CMS, our vendors/consultants, and industry experts to implement best-in-class practices.
• Receives assignments in the form of objectives and establishes goals to meet objectives.
• Ensures work flow procedures and guidelines are clearly documented and communicated.
• Special Projects as requested.


• Requires minimum of a bachelor's degree or equivalent combination of experience and education.
• Requires a minimum of 7+ years of healthcare industry experience.
Computer Skills:
• Programming knowledge required.
• 2 years of SAS/SQL or other database programming knowledge, preferred.
• Proficient with MS Office (Excel, Access, Word, PowerPoint, and Visio).
• 3 years of developing analytic reporting. The developed reporting should clearly demonstrate analytic insights into business/financial challenges.
Personal/Leadership Skills:
• Excellent interpersonal, verbal and written communication and presentation skills - especially presentations of complex, technical information to non-technical audiences.
• Independent problem solver, proactive, able to multitask. Patience for working on large scale problems.
Preferred experience:
• Medicare or Commercial Risk Adjustment Experience.
• VBA programming knowledge.
• Finance experience, including revenue and expense accounting.
• Healthcare Enrollment and Claims processing experience.
• Other healthcare experience, especially technical experience.


Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. - provided by Dice