Strategy Consultant IV, Medicare Policy and Audit Risk Adjustment Coder

Strategy Consultant IV, Medicare Policy And Audit Risk Adjustment Coder

Policy and Audit Risk Adjustment Coder : The Policy and Audit Risk Adjustment Coder ensures accurate and compliant coding within a Medicare risk adjustment framework with a strong focus on Risk Adjustment coding accuracy, audit readiness, and policy development. This position will support Health Plan coding and compliance initiatives with a strong focus on Risk Adjustment coding accuracy, audit readiness, and policy development.

Job Summary : Facilitates strategy development by defining moderately complex business problems and opportunities and identifying, weighing, and recommending alternative approaches. Performs moderately complex analysis and ensures interpretation of market data and tests hypotheses using advanced knowledge of qualitative and quantitative analytical tools to drive towards insightful and actionable insights for the business. Assembles moderately complex proposals for projects and programs to ensure progress on deliverables and effective execution to produce high-quality business outcomes. Ensures implementation of updated processes to improve Return on Investment (ROI), service quality, and operations for initiatives across teams. Fosters collaborative partnerships with inter / intraorganizational and external partners and builds and develops trusting relationships with key stakeholders.

Essential Responsibilities :

• Promotes learning in others by proactively providing and / or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional / external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and / or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Analyzes and interprets market data by : developing and implementing a plan to address moderately complex research questions and test hypotheses with advanced knowledge of data collection and analysis; performing moderately complex quantitative and qualitative analyses and investigating alternative hypotheses; and ensuring interpretation of key findings, conclusions, and recommendations for the future.
• Facilitates process improvement efforts by : ensuring the implementation of updated processes and beginning to identify opportunities to adapt processes to improve return on investment (ROI), operations, service quality, and results for initiatives across teams; utilizing moderately advanced knowledge of business operations to ensure the implementation of best practices across teams; and encouraging adoption of best practices and future innovations.
• Effectively manages projects and programs by : assembling project moderately complex proposals, including establishing objectives, key stakeholders, milestones, projecting required resources and timelines; ensuring progress on project deliverables in alignment with greater business strategy across a function; utilizing existing methodologies to complete initiatives with little support; and ensuring the execution of project plan, contributing to high-quality outcomes.
• Proactively maintains open streams of communication by : building and developing trusting relationships with stakeholders by navigating the organizational landscape; identifying moderately complex issues or risks to strategic program implementation and ensuring that they are resolved or escalated; fostering collaborative partnerships with inter / intraorganizational and external partners to develop and refine key priorities and strategy; and proactively communicating strategic issues and recommendations to senior leadership and across their function.
• Contributes to the development and execution of business strategy by : developing moderately complex strategic proposals based on business case and advanced knowledge of health care marketplace; assessing the scope of the problem to be addressed and the resources needed; identifying strategic options based on problem scoping; recommending challenging business goals and the processes and resources needed to accomplish them; ensuring alignment around the strategic plan and intended outcomes, and finding opportunities for collaboration and synergy within a function; ensuring application of strategies to mitigate moderately complex barriers, constraints, and risks to execution; and assessing and adjusting strategic direction in response to a changing environment.

Minimum Qualifications :

Additional Requirements :

Location : Fulton, Maryland

Company : KAISER

External hires must pass a background check / drug screen. Qualified applicants with arrest and / or conviction records will be considered for employment in a manner consistent with Federal, state and local laws.