Quality Performance & Initiatives, Professional, Risk Adjustment Analyst #773
Status: Full-time, Exempt
This position will be responsible for performing analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations to support various prospective and retrospective Risk Adjustment efforts. Duties can include but are not limited to: 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. Minimal travel is required. Performs other duties as assigned.
This position can be worked remotely (virtually) from any location within New York.
Bachelor’s Degree Health Administration, Business, Economics, Health Informatics, or related field.
2 years’ experience in a 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.
Previous Health Insurance experience preferred
- Demonstrated problem-solving and analytical abilities.
- Intermediate SQL skills
- Demonstrated ability to work independently with strong attention to detail.
- Ability to manage multiple projects and produce results within deliverable timelines
- Demonstrated excellent written and verbal communication skills.
- 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.
- Proven ability to analyze, report and provide insight on large sets of data
- Data visualization skills (Tableau, Power BI, etc.)
- Knowledge of MAO-002, MAO-004, RAPS
- R or Python
- Knowledge of CMS risk adjustment and reinsurance payment processes and audits for Medicare programs
- Knowledge of revenue and data issues relating to CMS and NYS encounter submissions
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