Best Practice Partners: Principal Consultant, Healthcare Economics

Lead the development of the client healthcare economics and risk adjustment services to assist in validating and ensuring compliance and accuracy of high-risk clinical profiles.

Best Practice Partners Company: Best Practice Partners
Location: Pennsylvania

Reports to: Director, Consulting Services

Position Summary
Our client has formed a new group specializing in population health management, health economics, healthcare data analytics and preventive medicine. Our client is looking to fix some fundamental problems in the healthcare industry and build a product and services organization. Due to growth, our client is looking to build out our Business Consulting team and need a Principal Consultant to join their team.

This position is responsible for leading the development and delivery of the client company's healthcare economics and risk adjustment services to assist clients in validating and ensuring compliance and accuracy of high-risk clinical profiles. In addition to consulting with clients, the position is also responsible in developing the product strategy for analytics, maintaining regulatory awareness, managing client relationship, and demonstrating evolving risk adjustment expertise to ensure the Company's competitiveness within the portfolio.

Essential Duties and Responsibilities (% of Time)
  • Leading engagements with specific business areas and customers primarily in Actuarial, Finance, and Medicare Operations with a focus on being a subject matter expert providing deep technical and business level of involvement to influence decisions. (20%)
  • Assists and leads business in the initial assessments, requirements, analytical and business intelligence solutions with a focus on risk models, financial data models, and financial analysis. (20%)
  • Partner with clients to develop their strategic vision and adapt to industry changes. Actively teams with other areas and Principals to pursue opportunities and generate revenue. (10%)
  • Drive business and program development where there is a need for data, information, reporting or analysis. Pull together appropriate resources to support collaborative strategies. (10%)
  • Drive business and program development where there is a need for data, information, reporting or analysis. Pull together appropriate resources to support collaborative strategies. (10%)
  • Attends industry conferences and events, both local and national, to maintain a contemporary awareness of industry, CMS regulations, Medicare and Commercial risk adjustment solutions, benefits and programs that will enhances strategy development, recommendations, and decision making. (5%)
  • Communicates results of analytic and reporting efforts to the customer in a way that demonstrates insights of all relevant business issues. (5%)
  • Serves as the primary liaison on issues related to expertise including competitive and industry intelligence including research, assessment and communication of information and business intelligence to support customer needs. Key focus on Risk Adjustment processes and HCC/HSS Programs, valuations and financial work. (10%)
  • Provide oversight to clients and staff in development of engagements, materials, events, initiatives, committees, meetings and presentations by gathering needed information and using appropriate frameworks and models in the development of assessment materials. (10%)
  • Coach and mentor Senior Business Consultants and Business Consultants on the team. (10%)

Job Requirements

1) Leadership:
  • Demonstrated project management skills involving multiple departments, customers, and initiatives.
  • Track Record of establishing and maintaining strong customer relationships.
  • Ability to communicate effectively in both written and oral form on general as well as complex subject matter in order to reach consensus on issues at the executive level.
  • Ability to analyze problems, requirements, and issues efficiently, determine the impact in the context of the matter being evaluated and develop effective business models/solutions.
  • Ability to act as a liaison and recommend solutions to a variety of departments, as well as other Plans and other external business partners.

2) Skills: Proficiency with software used for both analytic and reporting functions.

3) Knowledge:
  • In depth knowledge of areas of accountability: Healthcare Finance, Actuarial, Medicare Operations, related to strategy, related analytical and statistical applications to support information needs and decision making.
  • Specific to the area of accountability, knowledge health care financing, medical risk adjustment processes, and related HCC programs (RAF and CRA) and methodologies.

4) Experience:
  • Minimum of 10 years of related experience in the area of actuarial or business consulting. Experience in the health care or health insurance industry is a plus.
  • Demonstrated experience in strong analytical thinking.
  • Related professional experience in the area of accountability or as a Senior Business Consultant. Experience in big 5 consulting companies is a plus

5) Education, Certification, and Licenses: Prefer a Master's Degree in actuarial sciences, business administration, statistics or economics with an extensive track record of success in area of accountability.

6) Work Environment: Some travel required, including local, regional, and national locations.

7) Travel Requirements: Amount (up to 50% of time)

For more information and/or a confidential conversation, please contact:

Mark W. Stevens
Vice President
Best Practice Partners