Deloitte Advisory Senior Consultant - Healthcare Regulatory - Medicare Advantage in Pittsburgh, Pennsylvania
Deloitte's Risk & Financial Advisory provides you an opportunity to gain valuable hands-on experience working alongside leading professionals across diverse industries while building your professional skills in a variety of project experiences. Our Deloitte Risk & Financial Advisory practice helps organizations effectively navigate business risks and opportunities-from strategic, reputation, and financial risks to operational, cyber, and regulatory risks-to gain competitive advantage. We apply our experience in ongoing business operations and corporate lifecycle events to help clients become stronger and more resilient. Our market-leading team's help clients embrace complexity to accelerate performance, disrupt through innovation, and lead in their industries.
Work you'll do
As a Senior Consultant in our Regulatory Healthcare Practice, you will have the opportunity to work on multiple projects leveraging your education and prior work experience to help our clients more confidently make decisions to drive performance. You will help our clients embrace change, grow their business, accelerate performance, and navigate periods of crisis or controversy and emerge resilient.
Projects may be aligned to the following areas and include:
Operational Improvement: For business process that include significant regulatory requirements, you will improve efficiency and business outcomes by leverage process improvement, technology innovation and operating model evolution.
Strategic Risk: Helping clients to embrace their most significant regulatory risks, by enabling senior health care executives to plan for, spot, assess, manage, and respond to those risks to either avoid harm or to embrace risks as opportunity.
Regulatory Response: Supporting clients with their most pressing regulatory and operational challenges. Helping them to identify, remediate, monitor, and manage enterprise risks and create value through implementing a compliant, resilient enterprise. Includes helping clients manage and respond to internal and external investigations, regulatory concerns and other business controversy.
BS/BA Degree required in business, finance, accounting or other related subject
3+ years of experience working with Medicare Advantage Operational and Regulatory requirements within a health plan environment; or relevant consulting experience
Operational experience with Medicare functions such as Organization Determinations, Coverage Determinations, Appeals, Grievances, Care Management, Pharmacy Claims Adjudication
Experience configuring, deploying, and/or enhancing systems used to support Medicare core admin functions
Experience designing and implementing Compliance Program Effectiveness and FDR oversight models
Experience with Medicare Advantage Regulatory and Operational Requirements, including a thorough understanding of CMS Program Audit protocols, testing methodologies and success factors. Ability to execute a "Mock" CMS Program Audit
Experience working with business, compliance and IT to drive root cause analysis and solution design (people, process and technology) to address corrective actions
Practical experience with program management fundamentals; experience overseeing the end-to-end audit lifecycle - preparation through remediation and execution of issues, and ability to meet deadlines
Experience with federal and state regulatory requirements, regulatory compliance, and billing requirements
Experience leveraging data and analytics to enhance risk management, quality and compliance
Proficiency in verbal and written communication skills essential to interacting with clients and teams including presentation skills (MS Power Point, MS Visio)
Advanced proficiency with tools like Excel, Access, SQL, and Tableau
Ability to work independently and manage multiple projects/assignments/responsibilities in a fast-paced environment
Excellent problem-solving skills with a demonstrated ability to identify issues, resolve them quickly and know when to rely on internal resources to assist
Ability to travel 40% -50% on average, up to 80% based on the work you and the clients and industries/sectors you serve
Must be legally authorized to work in the United States without the need for employer sponsorship now, or at any time in the future
Previous consulting experience
Leading the development of proposals, marketing content, and thought leadership as a key contributor to developing new business
Master's degree in healthcare administration or related field, preferred
Experience with application security controls, risk and compliance
Experience in quality measurement, quality improvement, and value-based payment models
Experience in program and/or project management for technology implementations using third party software
Knowledge of process excellence (Six Sigma, LEAN, Design Excellence), certifications preferred
Experience training, educating and coaching
For individuals assigned and/or hired to work in New York City, Jersey City, California and Washington State, Deloitte is required by law to include a reasonable estimate of the compensation range for this role. This compensation range is specific to New York City, Jersey City, California and Washington State and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $90,938 - $160,938.
You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.