Healthcare Data Analyst - Risk Adjustment Medicare

Capital Blue Cross•Harrisburg, PA

About The Position

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” This role is responsible for supporting Capital Blue Cross Risk Adjustment Program analytics day to day activities impacting the programs strategy and operations. The Risk Adjustment Analyst works closely with the Risk Adjustment & Stars Programs Management leader(s) supporting the execution of the Program strategy through analysis and reporting tactics driving results to improve or maintaining risk adjustment compliance, cost and revenue, submissions process, and operations. The role will include support in the development of reports, enhancement to existing reports, data analysis, processes, and methodologies that will inform and enable the Risk Adjustment leader(s) to make informed decisions based on data and drive the execution of the Program strategy and operations effectiveness.

Requirements

Creating and applying data to problem solve
Consistent with delivering results on time and high quality/accuracy
Ability to communicate and summarize complex data processes, findings, etc. in a simple and clear way
Problem solving and critical thinking mindset that’s oriented to find solutions
Financial analytics knowledge with data mining principles: predictive analytics, mapping, collecting and complex manipulating data from multiple data systems
3 years of experience in risk adjustment and data analytics.
Financial analytics knowledge with data mining principles: predictive analytics, mapping, collecting and complex manipulating data from multiple data systems.
Highly skilled in Excel, SAS, Power BI, Snowflake, Sigma and other query/reporting tools.

Nice To Haves

Project and/or vendor management experience is a plus.
Preferred: Bachelor's or master's degree in data analytics, Data Science, Finance, Actuarial, Mathematics or Statistics, Public Health or Health-related Sciences, or Health Administration.

Responsibilities

Assist and/or develop new reports or analysis, enhance key existent reports and/or analysis processes, and methodologies of the Risk Adjustment Program operations and initiatives.
Support the implementation and on-going activities of vendor operations and analytics tools. Vendor management activities such as contract implementation, delegated activities execution from an analytics standpoint, and performance guarantees monitoring process.
Develop standardized reporting and controls for vendor’s management and performance monitoring process to ensure appropriate and timely data flow between teams.
Prepare contracts, projects, and/or initiatives performance reports, gap analysis, etc. based on key performance indicators. Communicate performance updates and findings to leadership.
Collaborate with Actuarial to project and monitor the impact of coding programs on revenue for forecasting and monthly financial statement accruals.
Data review, monitor and active participant in the completion of submissions for Medicare and Commercial/ACA products (e.g. RAPS/EDPS submissions).
Utilize analytics to identify trends, opportunities for improvement, and potential Programs development.
Collaborate with the Risk Adjustment & Stars Programs leader (s) and team to monitor and project year to date and end of year performance.
Participate on new projects, processes and/or workflows.
Support the development and implementation of remediation strategies (for internal and/or external business partners).
Support the development and maintenance of the Risk Adjustment tactics effectiveness. Creation of processes, documentation, and reporting infrastructure.