Senior Medical Financial Risk Evaluation Consultant

About the position

Become a part of our caring community and help us put health first. The Senior Medical/Financial Risk Evaluation Consultant/Professional is responsible for supporting the development, implementation, and monitoring of medical and financial risk. This role involves identifying, assessing, and mitigating any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events. The consultant maintains a balance between risk mitigation and efficiency, and begins to influence the department's strategy. Key responsibilities include system configuration for payment accuracy, project ownership, and a goal-oriented metrics focus on payment integrity. This position is crucial in ensuring that the organization can effectively manage risks while maintaining operational efficiency. The Senior Medical/Financial Risk Evaluation Professional will work closely with various stakeholders to ensure that all processes are aligned with the organization's goals and compliance requirements. This role requires a proactive approach to identifying potential risks and implementing strategies to mitigate them. The consultant will also be involved in analyzing data to support decision-making and improve overall performance. The ideal candidate will have a strong background in medical claims and financial recovery, as well as experience in documenting processes and workflows. This position is essential for driving improvements in risk management practices and ensuring the organization's long-term success.

Responsibilities
? Support the development, implementation, and monitoring of medical and financial risk.
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? Identify, assess, and mitigate medical or financial risks arising from inadequate processes, people, systems, or external events.
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? Maintain a balance between risk mitigation and efficiency.
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? Influence department strategy regarding risk management.
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? Configure systems for payment accuracy.
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? Own projects related to risk evaluation and management.
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? Focus on goal-oriented metrics to ensure payment integrity.

Requirements
? 3 or more years of Medical Claims experience.
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? 2 or more years of Audit and/or Financial Recovery experience.
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? Experience documenting processes and workflows.
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? 1 or more years working directly with Healthcare vendors and/or providers.

Nice-to-haves
? Direct experience working with Medicare claims.
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? Working knowledge of CPT, ICD10, and HCPC codes.
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? Provider contract experience.
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? Working knowledge of Microsoft Word, Excel, Visio, Access, and PowerPoint.
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? Experience in compiling, modeling, interpreting, and analyzing data to identify and explain variances and trends.
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? Compliance experience.

Benefits
? Medical, dental, and vision benefits.
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? 401(k) retirement savings plan.
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? Paid time off, including company and personal holidays, volunteer time off, paid parental and caregiver leave.
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? Short-term and long-term disability insurance.
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? Life insurance.
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? Bonus incentive plan based on company and/or individual performance.

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