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GuideWell Source · 2 months ago

Principal Health Business Analytics - Risk Adjustment

United States

Full-time

Onsite

Senior Level, Lead/Staff

$116K/yr - $189K/yr

8+ years exp

GuideWell Source is seeking a Principal Health Business Analytics professional to lead analytic strategy and execution for Medicare Risk Adjustment programs. This role involves partnering with cross-functional leaders to optimize revenue and compliance through actionable insights derived from complex data.

Health CareMedicalService Industry

Responsibilities

Lead analytic strategy for risk adjustment and align insights with enterprise financial and compliance goals

Analyze risk score trends, model performance, and program results to identify revenue and quality improvement opportunities

Partner with Finance and Actuarial to forecast revenue and assess CMS model impacts (e.g., V24 → V28)

Evaluate vendor, provider, and campaign performance for prospective, retrospective, and encounter programs

Ensure analytic integrity, data accuracy, and compliance with CMS risk adjustment requirements

Deliver clear, actionable insights and visualizations to senior leadership

Mentor analysts and advance the use of predictive modeling, automation, and performance dashboards

The essential functions listed represent the major duties of this role, additional duties may be assigned

Serve as strategy influencer and subject matter expert on assigned projects of high risk, complexity and impact to the business

Manipulate data using large datasets and multiple data sources

Act as primary Analyst for large projects and proactively identify topics for analysis

Analyze or assist in the analysis of processes and programs in achieving stated goals. Provide analyses and recommendations if corrections are needed. Investigates and discovers areas of opportunity

Develop advanced Excel-based models and spreadsheets containing advanced functions that are used to evaluate historical trends and forecasts and to identify best practices

Write advanced SAS and/or SQL programs for data extraction. Integrate data across multiple areas. Modifies existing programs for data extraction

Apply risk adjusters when applicable

Accountable for developing insightful and actionable summaries and recommending actions

Monitor and evaluate patterns, costs and trends

Recommend new analytical processes; partner with Information Management in the development of new analytical tools such as power pivots and analytical cubes to enhance analytical capabilities

Train team members on analytical tools and techniques including complex SAS and/or SQL, advanced Excel and detailed risk/analytical models. Provide guidance and review work of team members

Monitor emerging trends, provides strategy input to Director, prepares benchmarking reports and recommendations

Lead development of industry leading analytical methods, tools and models

Qualification

Risk AdjustmentSQLSASAdvanced ExcelPredictive ModelingData VisualizationAnalytical ToolsTrainingLeadershipCommunicationCritical ThinkingNegotiation

Required

8+ years related work experience

Related Bachelor's degree or additional related equivalent work experience

Experience using algorithms and inferential statistics

Advanced level experience writing SQL /SAS or related code

Advanced Excel skills

Proficient with Microsoft Office products

Ability to manage tasks independently, take ownership of responsibilities and meet deadlines

High critical thinking skills to evaluate alternatives and present solutions that are consistent with business objectives and strategy

Demonstrated leadership abilities including effective knowledge sharing and conflict resolution

Ability to train team members on advanced analytical tools and techniques (complex SAS and/or SQL, advanced Excel and detailed risk/analytical models)

In-depth business process knowledge of several key business functional areas

Expert-level ability communicating highly complex information clearly and articulately for all levels and audiences

Expert innovator with ability to think beyond established standards and processes

Expert-level knowledge and experience applying current and emerging trends

Expert consulting, negotiating, communicating, consensus building, presentation and facilitation skills

4 or more years of experience with health business