Strategy Consultant - Risk Adjustment Accuracy

highmarkhealth; Pennsylvania; Hybrid; USD 120,000 - 190,000; Full time

Job summary

Highmark Inc. seeks a strategic leader to guide the Risk Adjustment Accuracy Management (RAAM) function. You will analyze business issues, design analytics, and craft recommendations for senior leadership, shaping program strategy and operational goals.

Responsibilities include leading risk adjustment initiatives, guiding projects, and developing actionable insights and documents to inform critical decisions for Medicare Advantage, Medicaid, and ACA programs.

Qualifications

• Masters degree in Business, Healthcare, Economics or related field.
• 6 years of related experience in Business or Healthcare.
• Bachelor's degree plus 3 years of relevant strategic experience in lieu of Master's.

Responsibilities

• Identify key business issues with owners and apply analytical frameworks.
• Lead delivery of risk adjustment initiatives aligned with RAAM's plan.
• Manage strategy projects with internal/external resources.
• Serve as SME on Medicare Advantage, Medicaid, and ACA risk programs.
• Provide guidance and training to junior staff; potential project supervision.

Skills

Strategic thinking

Presentation skills

Communication

MS Office

Education

Masters Degree in Business, Healthcare, Economics or related degree

Bachelor's degree + 3 years relevant strategic experience in lieu of Master's

Tools

PowerPoint

Excel

Job description

Company : Highmark Inc.

Job Description :

JOB SUMMARY

This job supports leadership of the Risk Adjustment Accuracy Management (RAAM) department with a range of activities essential to RAAM's program strategy and operational goals . Provide analytical/strategic-thinking and leadership support that enables project teams to: 1) isolate business issues; 2) design and execute analytics for studying business issues (market research, scenario planning, forecasting, market share, profitability, etc.); 3) develop technical content (competitive intelligence, market trend analysis); 4) support development of formal recommendations to senior levels of Highmark leadership; 5) create documents (go-to-market or operational strategies, etc.) that inform critical strategic issues and decisions.

This role can be hybrid or remote. However if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, TH.

ESSENTIAL RESPONSIBILITIES

• Work with business/ market owners to identify key business issues, apply right analytical framework, develop solution and recommendations, represent findings to stakeholders and own the outcome.
• Lead the successful delivery of evolving risk adjustment initiatives and projects, driving outcomes directly aligned with RAAM's strategic plan
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Serve as subject matter expert to Strategic Operations staff and stakeholders on risk adjustment programs for Medicare Advantage, Medicaid, and ACA lines of business.
• Provide periodic informal work guidance/direction to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project basis.
• Develop analytical frameworks, approach and methodology best practices to analyze strategy issues.
• Other duties as assigned or requested.

EDUCATION

Required

• Masters Degree in Business, Healthcare, Economics or related degree
• 2 years of post-grad experience with strategy / management consulting firms (such as McKinsey, Boston Consulting Group, Booz & Company, Accenture (strategy Practice) or Deloitte (Strategy practice) ) or internal strategy groups of healthcare companies (such as Aetna, United Health Group, WellPoint, GE, )
• 6 years of related experience in Business or Healthcare

Substitution

• Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree

Preferred

• Extensive knowledge of Health Insurance and/or Provider operations
• Experience in operational improvement
• Extensive knowledge of government risk adjustment models, including CMS-HCC, HHS-HCC, and/or CDPS models
• Extensive experience in implementing and managing provider-facing and/or patient-facing programs for the purposes of ensuring complete and accurate risk documentation
• Through knowledge of membership, rates, financial, economic and competitive data

LICENSES or CERTIFICATIONS

Required

None

Preferred

None

SKILLS

• Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields
• Strong PC application Skills (MS Office including PowerPoint and Excel)
• Knowledge of healthcare industry trends and challenges
• Strong critical thinking skills
• Good communication and presentation skills

Language (Other than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

• Position Type
• Office-based or Remote
• Teaches / trains others regularly
• Occasionally
• Travel regularly from the office to various work sites or from site-to-site
• Never
• Works primarily out-of-the office selling products/services (sales employees)
• Never
• Physical work site required
• Yes
• Lifting: up to 10 pounds
• Constantly
• Lifting: 10 to 25 pounds
• Never
• Lifting: 25 to 50 pounds
• Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business