Risk Adjustment Operations Leader

Health Consulting

We work with C-suite executives, leaders and boards of the world's leading organizations, helping them reinvent every part of their enterprise to drive greater growth, enhance competitiveness, implement operational improvements, reduce cost, deliver sustainable 360° stakeholder value, and set a new performance frontier for themselves and the industry in which they operate. Our deep industry and functional expertise is supported by proprietary assets and solutions that help organizations transform faster and become more resilient. Underpinned by technology, data, analytics, AI, change management, talent and sustainability capabilities, our Strategy & Consulting services help architect and accelerate all aspects of an organization's total enterprise reinvention.

As a Risk Adjustment Operations Leader, your primary responsibilities may include:

Product Roadmap Development and Maintenance

• Lead the development and continuous refinement of the firm's risk adjustment product roadmap.

• Ensure the product offering leverages cutting-edge technology, including AI-driven chart reviews and advanced analytics.

Performance Management

• Establish and oversee performance management processes, ensuring operational excellence and superior client outcomes.

• Develop and maintain reporting frameworks to monitor performance metrics, identifying areas for improvement.

Client Management

• Serve as the subject matter advisor and primary point of contact for health clients for risk adjustment services.

• Proactively identify and communicate risks, issues, and improvement opportunities to clients.

• Set and manage client expectations, ensuring satisfaction and alignment with service objectives.

Regulatory Compliance

• Monitor regulatory changes, including CMS and HHS guidelines, and ensure risk adjustment services remain compliant.

• Oversee enhancements to processes and tools in response to evolving regulatory requirements.

Operational Excellence

• Oversee the performance of automated processes, including AI-based chart reviews and risk adjustment analytics.

• Identify opportunities to improve speed, breadth, and accuracy of risk adjustment operations.

Business Development

• Support sales initiatives, contributing to proposals and presentations to secure new clients.

• Leverage industry insights to identify growth opportunities and expand the firm's risk adjustment client base.

Team Leadership

• Build, mentor, and provide strategic direction to a team of junior resources.

• Foster a culture of continuous improvement, ensuring the team delivers high-quality, efficient services.

Travel

• As needed, up to 80%

Why should I join the Accenture Health team?    

•     Innovate every day. Be at the forefront of designing and delivering health technology solutions that push boundaries and create new opportunities for our clients.    

• Lead with the industry's best . Join an industry-recognized healthcare leader with more than 20,000 global healthcare professionals collaborating to drive enterprise-wide transformational projects on a global scale. Accenture has worked with more than 200 clients to deliver healthcare transformation to meet the diverse needs of patients and members.    

• Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health, consultative and delivery skills. With learning resources, interactive classroom courses, real-life client simulations and ongoing mentoring available when you need it, you'll expand your thinking beyond the core Workday implementation.    

Here's what you need:

• Bachelor's degree in Business Administration , Health Administration, Information Technology, or related field preferred.

• A minimum of 5 years of experience in healthcare consulting, or risk management operations with a health plan or risk adjustment service provider.

• A minimum of 5 years of experience planning, securing funding for, and executing a roadmap for continual improvement of risk adjustment capabilities .

Bonus points if you have

• Master's degree preferred.

• Experience working with or leading global teams. 

• Thrive in a diverse, fast paced environment. 

• Exceptional problem-solving and analytical skills.

• Excellent communication and presentation abilities.

• Leadership experience, including team management and project oversight. 

• Experience leveraging automation for medical chart capture and AI for supporting medical chart reviews.

• Experience presenting operational and financial impacts of risk adjustment services to health plan leadership.

• Participated in CMS compliance audits.

• Certified medical coder.

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What's in it for you?

You will be part of a diverse, vibrant, global Accenture community; teams pushing the boundaries of new business capabilities and emerging technologies and services, sharing their experiences and lessons learned with each other. You'll have the chance to thrive in an environment where your ideas are valued and your voice matters.

At Accenture, you will be able to work on meaningful and innovative projects, powered by the latest technologies and industry best practices such as event-driven architectures and domain driven design.

Accenture will continually invest in your learning and growth. You'll learn from and work with Accenture's certified practitioners and Accenture will support you in growing your own tech stack, sales skills, and certifications.

You'll be immersed in the design and implementation of human-centric solutions to help solve complex challenges with some of the world's largest companies.

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Illinois, Maryland, Minnesota, New York or Washington as set forth below.

We accept applications on an on-going basis and there is no fixed deadline to apply.

Information on benefits is here. (~~~)

Role Location Annual Salary Range

California $132,500 to $338,300

Colorado $132,500 to $292,200

District of Columbia $141,100 to $311,200

Illinois $122,700 to $292,200

Minnesota $132,500 to $292,200

Maryland $122,700 to $270,600

New York $122,700 to $338,300

Washington $141,100 to $311,200

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