Risk Adjustment Analyst
About The Position
You will be responsible for performing analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations. Provide analytical support on various prospective and retrospective objectives in population health management including focus on Risk Adjustment efforts. Design targeting based upon disparate data sources to identify members with likely risk gaps across. Provide regular reporting of Risk Adjustment programs and identify opportunities and obstacles. Measure capture rate of Hierarchical Condition Categories (HCC)s and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare and commercial exchange populations. Use Clinical Risk Group (CRG) software to target interventions for improved coding for Medicaid members. Calculates ROIs for Risk Adjustment programs. Maintain regulatory agency requirements for CMS and NYS related to supplemental data. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Requirements
- Bachelor's Degree Health Administration, Business, Economics, Health Informatics, or related field.
- 1 year experience in a health insurance or business environment involving the analysis of financial or other large data sets. Masters' Degree in relevant field may be considered in lieu of this experience.
- Demonstrated problem-solving and analytical abilities along with proven ability to analyze, report and provide insight on large sets of data
- Intermediate SQL skills
- Ability to manage multiple projects and produce results within deliverable timelines and ability to transform analytical output into simple to understand findings
- Intermediate Word skills, including the ability to create moderately complex documents containing tables and graphs
- Intermediate Microsoft Excel skills, including the ability to create simple formulas, insert rows, link data, enter and sort data and produce graphs and charts
- Data visualization skills (Tableau, Power BI, etc.)
- Curiosity to foster innovation and pave the way for growth
- Humility to play as a team
- Commitment to being the difference for our customers in every interaction
Responsibilities
- performing analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations
- Provide analytical support on various prospective and retrospective objectives in population health management including focus on Risk Adjustment efforts
- Design targeting based upon disparate data sources to identify members with likely risk gaps across
- Provide regular reporting of Risk Adjustment programs and identify opportunities and obstacles
- Measure capture rate of Hierarchical Condition Categories (HCC)s and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare and commercial exchange populations
- Use Clinical Risk Group (CRG) software to target interventions for improved coding for Medicaid members
- Calculates ROIs for Risk Adjustment programs
- Maintain regulatory agency requirements for CMS and NYS related to supplemental data
- performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Insurance Carriers and Related Activities
Number of Employees
1,001-5,000 employees
