Senior Risk Adjustment Data Analyst - Remote
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About The Position
Sentara Health is looking for a Senior Risk Adjustment Data Analyst to join our team! This position is 100% Remote, but candidates must have a current residence in one of the following East Coast states, or be willing to relocate: Delaware, Florida, Georgia, Maine, Maryland, New Hampshire, North Carolina, Pennsylvania, South Carolina, Virginia, West Virginia. The Senior Risk Adjustment Data Analyst provides data analysis supports to Sentara Health Plans' Revenue Management team, affiliated internal departments, and external vendor partners. The Senior RA Analyst supports in designing and implementing processes and solutions utilizing a wide variety of data sets to resolve business challenges in relation to optimizing Risk Adjustment premium revenue. The senior analyst uses a combinations of data/text mining, analysis, reporting, predictive and risk modeling to support informed business decisions. This requires complete understanding of claims, pharmacy, lab, network utilization, and cost containment data. Additionally, familiarity with external data sources including Medicare, Medicaid, and Health Exchange data files is required. The Senior RA Data Analyst is required to show independent thinking. The senior analyst assists in identifying business challenges, support development of processes to address the challenges, and metrics to track and monitor business processes. This requires a high level of understanding of Centers for Medicare and Medicaid (CMS), Health and Human Services (HHS), or Virginia Department of Medical Assistance (VA-DMAS) Risk Adjustment programs.
