Professional, Risk Adjustment Analyst

MVP Health Care • Schenectady, NY

1d • $69,383 - $92,279 • Hybrid

About The Position

MVP Health Care is seeking a Professional Risk Adjustment Analyst to join our Population Health Analytics team. In this role, you will be responsible for performing analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations. 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.

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.
• 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.

Benefits

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
• Competitive compensation and comprehensive benefits focused on well-being
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees