Disease Burden (HCC) Business Intelligence Developer

Corewell Health • Grand Rapids, MI

3d • Onsite

About The Position

We are seeking a highly analytical and detail-oriented Risk Adjustment Reporting Developer to support our organization’s Medicare Advantage, ACO, ACA, and other risk-based programs. This role is critical in reporting, trend analysis, RAF analytics, and provider opportunity targeting. The ideal candidate understands CMS risk-adjustment methodologies, coding impacts, and can turn data insights into actionable strategies for providers, CDI, and clinical teams. Job Summary Partners with the business to turn data into critical information and knowledge. Possesses a fundamental understanding of healthcare and/or data and analytics. Develops reporting and analytic solutions with knowledge of the primary source data (i.e., electronic health record, claims) and workflows. Develops relationships with users for direct consumption or integration with other systems. BI Developers promote data literacy by educating and training customers to use the data as an analytical tool, displaying the information for the purpose of analysis and exploration. Under minimal supervision, designs, codes, configures, tests, debugs, deploys, documents, and maintains programs. Uses a variety of software development tools, programming languages and testing/verification applications. Their work adheres to development best practices and quality standards. Gathers business requirements and translates the information into detailed technical specifications from which programs will be written or configured, and to validate that the proposed applications align with both the architectural design and business needs. Works closely with other BIDs, Data Engineers, Data Scientists, and internal/external customers. Essential Functions Risk Adjustment Analytics & Reporting Develop and deliver recurring and ad-hoc reports on RAF trends, HCC capture rates, provider performance, and suspect lists. Analyze large datasets (claims, EHR, encounter files) to identify gaps and missed opportunities. Monitor RAF impacts, HCC prevalence, V28 mapping changes, and quality indicators. Build dashboards and visualizations using Epic, Power BI, Tableau, or similar tools. Provide actionable insights to support coding, CDI, and provider education. Provider Targeting & Opportunity Identification Create provider-level opportunity lists for chronic conditions, recapture needs, and care gaps. Collaborate with CDI, coding, and provider relations teams to prioritize outreach strategies. Analyze documentation trends and recommend workflow improvements. Trend Monitoring & Forecasting Conduct year-over-year HCC trend reviews and measure program effectiveness.

Requirements

• Bachelor's Degree or equivalent in business, liberal arts, computer science, application programming, software development, information systems, database administration, mathematics, engineering, or related field
• 2 years of relevant experience
• EPIC Cogito Certification held within 6 months of hire

Nice To Haves

• Prior work in payer, ACO, MSO, or risk-bearing provider group.
• Experience in risk adjustment analytics, RAF modeling, or healthcare data analysis.
• Strong understanding of ICD-10-CM, HCC coding, V28 models, and risk-adjustment methodologies.
• Ability to analyze complex datasets and present actionable insights.
• Excellent communication skills for non-technical audiences.
• Epic Certifications in Cogito, Clarity and Caboodle held upon hire

Responsibilities

• Develop and deliver recurring and ad-hoc reports on RAF trends, HCC capture rates, provider performance, and suspect lists.
• Analyze large datasets (claims, EHR, encounter files) to identify gaps and missed opportunities.
• Monitor RAF impacts, HCC prevalence, V28 mapping changes, and quality indicators.
• Build dashboards and visualizations using Epic, Power BI, Tableau, or similar tools.
• Provide actionable insights to support coding, CDI, and provider education.
• Create provider-level opportunity lists for chronic conditions, recapture needs, and care gaps.
• Collaborate with CDI, coding, and provider relations teams to prioritize outreach strategies.
• Analyze documentation trends and recommend workflow improvements.
• Conduct year-over-year HCC trend reviews and measure program effectiveness.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees