Medicare Advantage Quality Consultant - Hybrid Role

Highmark; Camp Hill (Cumberland County); Hybrid; USD 90,000 - 140,000; Full time

Job summary

Highmark Inc. seeks a Medicare Advantage Quality Consultant to optimize government programs for primary care practices.

You will analyze Medicare STARS, Medicaid HEDIS, and risk revenue streams, identifying ROI opportunities and driving value creation through strategic, hands-on support to PCPs in collaboration with cross-functional teams. The role requires five years in Medicare/Medicaid and risk revenue, strong data analysis skills, and experience with population health tools.

Qualifications

• Bachelor's degree in a clinical or healthcare related field required.
• Master's degree preferred in a clinical/healthcare related field.
• 5 years in Medicare/Medicaid and risk revenue, primary care, or related government programs required.
• 3 years in data analysis, interpretation and outcomes strategic planning.

Responsibilities

• Provide hands-on, office-based support to PCPs for analysis of Medicare STARS, Medicaid HEDIS and risk revenue performance.
• Analyze government value-based reimbursement reports and develop strategic plans to meet program targets and ROI.
• Collaborate with inter-departmental teams and PCPs to transform workflows for better government program outcomes.
• Present program results to internal and external audiences, including practice meetings.

Skills

Healthcare analytics

Communication skills

Strategic thinking

Data interpretation

Stakeholder engagement

Education

Bachelor's Degree in a clinical or healthcare related field

Master's Degree in a clinical or healthcare related field

Tools

Predicative analytics tools

Job description

Highmark Inc. seeks a Medicare Advantage Quality Consultant to optimize government programs for primary care practices.

You will analyze Medicare STARS, Medicaid HEDIS, and risk revenue streams, identifying ROI opportunities and driving value creation through strategic, hands-on support to PCPs in collaboration with cross-functional teams. The role requires five years in Medicare/Medicaid and risk revenue, strong data analysis skills, and experience with population health tools.