Senior Risk Adjustment Analyst - St. Luke's Health Plan

St. Luke's Health System•Boise, ID

2d•Remote

About The Position

The Risk Adjustment Analyst serves as a strategic partner to the business segments within the St. Luke’s Health Plan. This role requires knowledge, technical skills, and experience in risk adjustment for QHP/ACA and Medicare Advantage. The analyst will lead the development of business processes and delivery of insights and health insurance data analysis, while working with cross-functional stakeholders. While this is a fully remote position, candidates must reside in Idaho, Utah, Oregon, or Arizona.

Requirements

Bachelor’s degree or experience in lieu of degree
Six (6) years' relevant experience
Must reside in Idaho, Utah, Oregon, or Arizona

Nice To Haves

Experience in QHP/ACA and Medicare Advantage Risk Adjustment Analytics
Experience in MA Encounter Data Submission
Experience in EDGE Server Data Submission
Strong skills in SQL
Knowledge of HEDIS and Stars

Responsibilities

Analyzes and interprets health insurance data, including eligibility, premium, medical, and pharmacy claims data. Serves as a subject matter expert on available health insurance data and a creative problem solver in applying that data to identify, escalate, and resolve operational issues.
Understands and interprets operational processes and business context to translate technical, clinical, financial, and operational problems into analysis, which yield insights and information to support decision making.
Performs high value health insurance data analysis, interpretation of key business metrics, and presents insights to business leaders and key stakeholders to aid decision making and operational planning.
Challenges and supports business decisions with analytical rigor, insights, and judgments to drive better decisions.
Partners with internal Data & Analytics team to define scope, requirements, data validation, and provide prioritization input on requests and needs. Collaborates with vendors and other external parties to develop data requirements and ensures appropriate data validation and integrity.
Works with and contributes to data management and data governance to understand and help define data policies and standards to ensure high quality data and analytics.
Develops and maintains a high degree of functional, analytical, and technical acumen. Builds successful partnerships with key internal customers and cross functional teams.
Responsible for and performs all but the most complex assignments and work requiring independent judgment and decision making. Serves as a subject matter expert for colleagues in other functions.
Leads special projects and participates on workgroups and teams, as assigned.
Completes other duties and responsibilities as assigned.