Senior IT Consultant - Risk Adjustment, CMS, MAOs, ACA, ESBRs
Primary Location Pleasanton, California
Worker Location Remote
Job Number 1356522 Date posted 05/15/2025
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Description:
In addition to the responsibilities listed below, this position is responsible for providing support for customers (users), and assigned applications and/or information systems, including software implementation, cross-functional integration, complex configuration, and testing.
Additional responsibilities also include leading solution design support efforts and research initiatives for translating requirements into workable technical solutions, and supporting the evaluation of third-party vendors as directed.
Job Summary:
In addition to the responsibilities listed below, this position is responsible for providing support for customers (users), and assigned applications and/or information systems, including software implementation, cross-functional integration, complex configuration, and testing.
Additional responsibilities also include leading solution design support efforts and research initiatives for translating requirements into workable technical solutions, and supporting the evaluation of third-party vendors as directed.
Essential Responsibilities:
- Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks, as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; evaluating recommendations made; and influencing the completion of project tasks by others.
- Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and improve opportunity areas; and adapting to and learning from change, difficulties, and feedback.
- Develops requirements, or leads a team of IT consultants in the development of requirements for complex or specialized process or system solutions which may span multiple business domains by partnering with stakeholders and appropriate IT teams (for example, Solutions Delivery, Infrastructure, Enterprise Architecture).
- Leverages multiple business requirements gathering methodologies to identify business, functional, and non-functional requirements (for example, SMART) across the enterprise.
- Leads and oversees the development and documentation of comprehensive business cases to assess the costs, benefits, ROI, and Total Cost of Ownership (TCO) of complex solution proposals.
- Provides insight, guidance, and recommendations throughout the evolution of applications, systems, and/or processes to a desired future state by maintaining and leveraging a comprehensive understanding of how current processes impact business operations across the enterprise.
- Maps current state against future state processes.
- Defines the impact of requirements on upstream and downstream solution components.
- Provides insight and influence to senior management and business leaders on how to integrate requirements with current systems and business processes across the enterprise.
- Reviews, evaluates, and prioritizes value gaps and opportunities for process enhancements or efficiencies.
- Influences solution design by providing insight and consultation at design sessions with IT teams to help translate requirements into workable business solutions.
- Recommends and advocates for additional data and/or services needed to address key business issues related to process or solutions design.
- Participates in evaluating third-party vendors as directed.
- Drives continuous process improvement by leading the development, implementation, and maintenance of standardized tools, templates, and processes across the enterprise.
- Recommends and advocates for regional and national process improvements which align with sustainable best practices, and the strategic and tactical goals of the business.
Minimum Qualifications:
- Minimum two (2) years experience in software or system testing across multiple IT environments.
- Minimum one (1) year software or application development experience.
- Bachelors degree in Business Administration, Computer Science, CIS or related field and Minimum eight (8) years experience in IT consulting, business analysis, or a related field. Additional equivalent work experience may be substituted for the degree requirement.
Additional Requirements:
Preferred Qualifications:
- Oracle database design, SQL and PL/SQL Development
- System software architecture and design for ETL processing
- Knowledge of Healthcare claims data
- Knowledge of X12 837 PROF, INSTN and DME claims.
- Knowledge of CMS Acknowledgment Flows. 999 , 277CA, MAO001, MAO002. MAO004
- Knowledge of ACA Edge Server Business Rules, claim flows and acknowledgements
- Risk Adjustment
Primary Location: California,Pleasanton,Pleasanton Tech Cntr Building A
Additional Locations:
Corona Data Center Admin, 1830 California Ave., Corona,California, 92881
6000 Meadows 6000 SW Meadows Rd., 6000 SW Meadows Rd., Lake Oswego,Oregon, 97035
Greenwood Plaza IT, 6560 Greenwood Plaza Blvd., Greenwood Village,Colorado, 80111
Pershing Point Plaza IT, 1375 Peachtree St. NE, Atlanta,Georgia, 30309
New Carrollton Administration, 4000 Garden City Dr., Hyattsville,Maryland, 20785
Renton Administration - Adams, 2921 Naches Ave. SW, Renton,Washington, 98057
Hawaii Remote Workers Location, 415 S Beretania St, Honolulu,Hawaii, 96813 Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Remote Employee Status: Regular Employee Group/Union Affiliation: NUE-IT-01|NUE|Non Union Employee Job Level: Individual Contributor Specialty: IT Consulting Department: KPIT ADMIN - RISK ADJUST PROG DEL - 9601 Pay Range: $147200 - $190410 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location. Travel: No Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status. Submit Interest
Corona Data Center Admin, 1830 California Ave., Corona,California, 92881
6000 Meadows 6000 SW Meadows Rd., 6000 SW Meadows Rd., Lake Oswego,Oregon, 97035
Greenwood Plaza IT, 6560 Greenwood Plaza Blvd., Greenwood Village,Colorado, 80111
Pershing Point Plaza IT, 1375 Peachtree St. NE, Atlanta,Georgia, 30309
New Carrollton Administration, 4000 Garden City Dr., Hyattsville,Maryland, 20785
Renton Administration - Adams, 2921 Naches Ave. SW, Renton,Washington, 98057
Hawaii Remote Workers Location, 415 S Beretania St, Honolulu,Hawaii, 96813 Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Remote Employee Status: Regular Employee Group/Union Affiliation: NUE-IT-01|NUE|Non Union Employee Job Level: Individual Contributor Specialty: IT Consulting Department: KPIT ADMIN - RISK ADJUST PROG DEL - 9601 Pay Range: $147200 - $190410 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location. Travel: No Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status. Submit Interest
