Senior Risk Adjustment Data Analyst - Remote

Summary Of Job

Provide complex analytical and reporting/data mining support to the Risk Adjustment Department for Medicare, Medicaid and HIX products. Perform data and analytical services in support of optimizing risk adjusted revenue, maintaining compliance with CMS standards and modeling financial impacts of changes in risk adjustment data and methodologies. Must have strong Risk Adjustment experience/knowledge. Collaborate regularly with internal departments, including but not limited to: Finance, Medicare Operations, Network Management, Provider Contracting, and Health Economics, and external vendors on risk adjustment projects. Organize, prioritize, and manage various simultaneous tasks/projects to meet deadlines. Understand various areas of the business and operational processes relevant to the project’s goals. Provide technical support to leadership on prospective risk adjustment programs. Assist in performing analyses used in the development of financial plans, re-forecasts, and other financial projections. Work on identifying gaps in the claims, encounter reconciliation process, and provide insights to educate providers. Build reports and dashboards to track risk adjustment related projects and to track the effectiveness of the initiatives. **

Responsibilities**

• Develop and maintain a sophisticated database where large volumes of data can be loaded, and information extracted for monthly dashboard reporting.
• Calculate ROI for risk adjustment vendors, initiatives and projects.
• Prepare complex monthly revenue valuation analysis, identifying & attributing proper credit to all initiatives.
• Produce trends month by month, year over year and other complex reports & analyses.
• Interact with business teams to gather the requirements and translate technical language.
• Map documents after the necessary data analysis.
• Lead meetings with internal technical teams on in office program solutions
• Provide analysis and recommendations for process improvements.
• Ensure accuracy of all monthly & supplemental data feed extracts.
• Liaise with IT and vendors' management teams on data issues & findings.
• Deliver projects, reports, updates, etc. on timely basis.
• Develop programs extracting specific claims details to create request files to FFS groups for wrap-around data.
• Clean & properly format files, ready for EH Submissions team.
• Produce ad hoc reports as requested.
• Participate in special projects; and perform related duties as assigned.

Qualifications

• Bachelor’s Degree in Finance, Health Care Management or related field (Required)
• 4 – 6+ years of relevant, professional working experience including experience with Information Management/Analysis within a Healthcare environment, preferably within the payer provider contracting or utilization management area (Required)
• Proficiency with MS Office (Word, Excel, PowerPoint, Outlook); strong SAS, Access and Oracle database skills (Required)
• Ability to effectively calculate and communicate forecasts/projections (Required)
• Proven track record of successfully managing multiple tasks/projects with competing deadlines (Required)
• Strong communication skills (verbal, written, presentation, interpersonal) with all levels/types of audiences (Required)
• Working knowledge of CPT, RBRVS, ICD codes and CMS-HCC Risk Adjustment Payment Methodology (Required)

Additional Information

• Requisition ID: 1000001448
• Hiring Range: $63,000-$110,000