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Deloitte Advisory - Manager - Healthcare Regulatory in San Jose, California

Business Overview

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 manager in our regulatory healthcare practice, you will have the opportunity to lead 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.

  • Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory and contractual requirements while also determining that payments are appropriate for the type and level of care provided.

  • 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.

    Qualifications Required:

  • BS/BA Degree required in business, finance, accounting or other related subject

  • 6+ years of experience working with health plans, healthcare providers, or other healthcare sector companies (e.g. Pharmacy & Life Sciences); or relevant consulting experience

  • Experience with healthcare payer or provider operations

  • Experience with federal and state regulatory requirements, regulatory compliance and billing requirements

  • Experience with medical related data sets, including medical services documentation and claims data

  • Demonstrated experience as a senior resource assisting in the definition of systems strategy, gathering and documenting business requirements, leading practice gap analysis, business process redesign, implementation of futures state recommendations and process improvement including functional configuration, testing, client user training, as applicable

  • Proven ability to understand the impact of technical changes, and, to articulate high level technical solutions to address business problems

  • Excellent problem-solving skills with a demonstrated ability to identify issues, resolve them quickly and know when to rely on internal resources to assist

  • An innovative thinker, collaborative business partner, who is well-organized and detailed with strong presentation and reporting skills is recommended

  • Professional demeanor, ability to interact with and lead diverse teams, and communicating with client managers, directors, and VPs including CFO, CCO, CNO/CMOs and CXOs.

  • Strong verbal, presentation and written communication skills as well as ability to lead in an environment of ambiguity with diverse stakeholders

  • Practical experience in project management fundamentals, ability to meet deadlines, and manage a budget and resources' utilization

  • Willingness to mentor and develop team of consultants

  • Ability to travel up to 80% (While up to 80% travel is a historical requirement of the role, due to COVID-19, non-essential travel has been suspended until further notice. Our travel requirements post COVID-19 return to work are to be determined but are likely to be less than 80%)

Preferred/Appreciated

  • 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

  • Any healthcare certification such as RHIA, CMM, AAHAM, CPHRM, CPHIMS, FACHE, preferred

  • Experience with application security controls, risk and compliance

  • Experience in quality measurement, quality improvement, and value-based payment models

  • Proven applicable CPT and ICD-10 coding experience; APR-DRG, MS-DRG and HCC assignment; coding certification and CCDS preferred

  • Prior EHR implementation experience including CDM Management, Charge Capture, HIM/Coding, and Clinical Documentation (e.g. Epic, Cerner); other clinical application experience and certifications desired

  • Other revenue cycle experience including conducting charge capture and coding reviews for compliance with billing and coding regulatory requirements

  • 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

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.

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