46 applicants

Company

Martin's Point Health Care · 2 days ago

Senior Risk Adjustment Analyst

United States

Full-time

Remote

Senior Level

5+ years exp

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FitnessHealth Care

No H1B

Hiring Manager

Allison Kavin, MBA

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Responsibilities

Examines and performs data management analyses and develops and presents a variety of performance results in addition to other pertinent communication

Transfers data into meaningful, professional, and easy to understand formats for leadership

Reviews data, develops recommendations and reviews findings with senior leadership

Analyzes and extracts data from the Enterprise Data Warehouse (EDW) and other sources to report to internal and external customers

Designs, develops, tests, documents, and maintains database queries for ad hoc reporting used in complex conceptual analyses for all departments within Risk Adjustment Operations

Develops systematic reporting processes and procedures to ensure timely delivery of daily, weekly, monthly, annual, and ad hoc reports to support key departmental and organizational initiatives

Serves as the liaison between departments including IT and Finance for all Risk Adjustment reporting needs

Troubleshoots errors and data inconsistencies and coordinates resolutions to issues as directed by self, staff, and various levels of leadership

Takes a lead role in the tracking of progress and activities of key initiatives

Plans and assists with testing processes and activities including new report or analytics methodology validation

Responsible for documenting and updating changes to workflow, training plans, policies and procedures and ensure redundancy in these knowledge areas with other analytics resources

Provides analytic mentorship and guidance to operational departments related to revenue optimization

Participates in the development of risk adjustment operational and strategic planning processes

Subject matter expert in CMS HCC Risk Adjustment modeling

May lead vendor research, software installation, configuration support, and interface development applications as needed

Maintains and is expert user of third-party analytical tools and reporting platforms related to risk profile analysis and HCC coding

Recommends tools and methodologies that can be deployed at the organizational level, to the departments and with external partner

Qualification

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Data Management AnalysisRevenue OptimizationEnterprise Data Warehouse (EDW)Database Query DevelopmentRisk Adjustment ModelingThird-party Analytical ToolsReporting ProcessesCost-benefit AnalysisROI AnalysisAnalytical MentorshipProject Team LeadershipProcess ImprovementTraining Plan Development

Required

Bachelor’s degree in Economics, Finance, Statistics, Mathematics, Actuarial Sciences, or other quantitative discipline

Minimum of 5 years’ experience related to reporting and analysis of health care data ideally in the areas of managed care, health care delivery, code sets, and/or reimbursement

Experience in developing cost-benefit and ROI analyses

In compliance with MPHC’s Department of Defense government contract, any/all persons hired for this position will need to verify their US citizenship and complete the required employment eligibility verification upon hire.