Responsible for leading the process of preparation and interpretation of complex risk adjustment, revenue or financial analysis for the Medicaid line of business.
Has end to end ownership/management of Medicaid Risk Adjustment business processes and works across multiple Medicaid markets to drive holistic and consistent solutions.
Leads risk adjustment and revenue initiatives aimed at improving business processes and, in some areas, developing innovative financial system solutions to reduce manual and repetitive work.
Manages enterprise or Medicaid business unit activities related to business case development, ROI analysis, cost-benefit realization, and other support for company investments.
Advises management by presenting solutions and recommended actions.
Mentors and trains team members.
Performs and documents complex risk adjustment, financial, and business analyses, including evaluations of financial and risk score performance, market nuances, and other revenue-related initiatives.
Prepares detailed analyses and reports for leadership and collaborates closely with internal and external auditors.
Partners with business teams to identify and implement strategic projects and risk adjustment programs that support company objectives.
Ensures compliance with state and federal regulatory requirements for risk adjustment functions across the enterprise.

Requires a BA/BS in Accounting or Finance and a minimum of 6 years budgeting, forecasting, and accounting financial reporting experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications: MBA, MPH, MHA, CPA, CMA, FSA and/or CFA preferred.
Strong knowledge of internal business processes, data flow, controls and our financial systems preferred.
Strong knowledge of risk adjustment practices, Medicaid risk adjustment models, and Medicaid categories of aid (acute R.A. vs. MLTSS R.A.)
Experience with Snowflake, SQL, SQL Server, or equivalent strongly preferred.
Ability to present meaningful results to a business audience, to participate collaboratively in a team tasked to produce complex analyses on a rigorous schedule.

Financial Consultant Manager

Key skills