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Emergent Holdings · 2 days ago

Senior Health Care Analyst-Risk Adjustment

United States

Full-time

Remote

Mid, Senior Level

$72K/yr - $120K/yr

7+ years exp

Emergent Holdings is seeking a Senior Health Care Analyst who will be responsible for planning, organizing, and leading department assignments related to Medicare Risk Adjustment. The role involves analyzing clinical, claims, and enrollment data to ensure compliance with regulations and improve risk adjustment strategies.

Health CareInformation ServicesInformation TechnologyInsuranceMedical

Comp. & Benefits

Responsibilities

Provide analytical support on prospective and retrospective initiatives, trends and identify areas for improvement

Uses a combination of data/text mining, analysis, reporting, predictive and risk modeling to support leadership and business decisions

Builds and supports business reports to be included in executive dashboard

Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues

Possesses and maintains an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles and methodologies.Manages and monitors multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters

Develops lines of communication to discuss and review results of analysis to management via reports and presentations and assists management in implementing programs that provide solutions

Investigates, reviews, recommends, communicates, and implements solutions which identify problems/root cause of issues

Identifies and resolves challenges in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities

Independently develops and plans reports, papers, and/or other materials in a clear and concise manner

Provides expertise and guidance to unit and corporate staff as required

Acts as a liaison between corporate business areas and participates in group or committee discussions

Supports ongoing maintenance of executive dashboard and related products, applications, and platforms, continuously striving towards automation

Works with analytics business analysts/developers and operations personnel to automate dashboard functions

Completes ad hoc data and analytic requests as assigned

Qualification

CMS Medicare HCC modelsSASSQLPythonRData visualizationAnalytical skillsProblem solvingCommunication skillsTeamwork

Required

Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics, Mathematics, or a related field

Seven years experience in a related field, typically in two subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management)

Knowledge of CMS Medicare HCC risk adjustment models and methodologies, ICD-10 coding, and interacting with large amounts of healthcare data

Working knowledge of data languages such as SAS, SQL, Python, or R

Excellent analytical, planning, problem solving, verbal, and written skills to communicate complex ideas

Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.) and data visualization skills (PowerBI, Tableau, etc.)

Ability to work independently, within a team environment, and communicate effectively with employees at all levels

Preferred

Master's degree in a related field is preferred

Certification or progress toward certification is highly preferred and encouraged

CMS reporting, Medicare data reporting, claims data reporting, and enrollment data reporting preferred

Company

Emergent Holdings

Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities.

Founded in 2000

Lansing, Michigan, USA

1001-5000 employees