Associate Director, Risk Adjustment Data and Analytics

Blue Cross Blue Shield of Massachusetts•Boston, MA

1d•Onsite

About The Position

Under the direction of the Senior Directory of Medicare Risk Adjustment and Analytics, the Director of Risk Adjustment Data and Analytics is responsible for developing and executing the analytic plan for the Medicare and Merged Market segments. The Director of Risk Adjustment Data and Analytics will oversee the reporting, analytics and management of risk adjustment, internally and externally. The role is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and systems to meet business objectives, partnership with Actuarial and Provider Contracting, management of external vendors, and compliance with CMS regulations. This leader is responsible for analysis, projections, and assessment of risk adjustment performance.

Requirements

Excellent knowledge of Medicare risk adjustment model
Knowledge of Medicare and risk adjustment data and system interfaces required
SAS/SQL experience required.
Demonstrated attention to detail, delivering quality results and operating collaboratively as part of a team
Experience in managing technology-related projects with vendors, IT and corporate partners
Proven success in managing people and achieving business goals and objectives
Ability to develop strong working relationships and to influence key internal constituents
Documented strength in analysis, identification of problems, and problem resolution
Proven track record of meeting timelines, deliverables, attention to detail and quality results
Strong organizational skills with ability to work under pressure, multitask and prioritize workload
Ability to identify, communicate, and manage risk
Effective presentation, facilitation, project management and planning skills
Bachelor’s degree required
A minimum of 7 years of Medicare risk adjustment experience
Minimum 5 years of progressive leadership experience preferred
Must be highly organized and capable of handling a multitude of projects at once
Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above

Nice To Haves

Other experience with the use of software for data analysis, extraction, and manipulation (e.g., Python, R), data visualization (e.g., Tableau) and analytic automation (e.g. scripting, macros) preferred
Master’s degree preferred
Project Management and IT experience a plus

Responsibilities

Responsible for direct leadership of the Risk Adjustment Performance and Strategic Analytics Team and the Risk Adjustment Data and Analytics Team
Design and develop metrics, reports, and dashboards to drive key strategic and tactical decisions, ensuring alignment of resources as needed, and balance workloads
Coordinate risk adjustment analytics throughout the broader organization
Investigate risk adjustment trends across all areas including enrollment, providers and claims to suggest business improvements and efficiencies
Represent the Risk Adjustment Team on internal workgroups and committees focused on reporting, analytics, and operations
Ensure business deliverables are being met and risk adjustment data is provided to Government Programs leaders and internal business leaders to inform strategic initiatives
Act as the primary contact for facilitating resolution (via analysis and reporting) on urgent issues and/or issues escalated by risk adjustment leaders.
Drive innovation and improvements through deep dive analytics; improve risk adjustment processes; increase efficiency and productivity and improve overall plan performance
Oversee the assessment of reporting requests, compilation, and distribution of routine and ad hoc reports for internal and external constituents
Coach, mentor, and develop analytic team members to increase their skill sets, enhance their subject matter knowledge, and improve their effectiveness to support other business areas
Oversee submission of BCBSMA’s Encounter Data submission to CMS and resolution of errors
Represent the Risk Adjustment Team’s interests through influence and negotiation in cross-functional workgroups that have a technology focus, are strategic around risk adjustment data and systems, or pertain to new projects.