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Senior Risk Score Data Analyst
Mass General BrighamSomerville, United Statesfull_timeVerifiedPosted 8 Jul 2025
About the role
Site: Mass General Brigham Health Plan Holding Company, Inc.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
Under the direction of the Risk Score Manager, this analyst is responsible for providing primary analytic support to the Risk Score Management program with the objective of improving the accuracy of member risk profiles. This analyst will develop and produce reports based on risk adjustment data from several data sources, work with both internal and external departments to identify opportunities for risk score improvement, and manage multiple risk score projects. This analyst will be responsible for targeted member tracking for medical record audits and outreach, vendor management and provider engagement. This analyst will be required to lead analytic projects with minimal supervision, as well as mentor and train other analysts in both the Risk Score Management department and other departments within the organization that also use the data, such as Medical Economics and Clinical.
ESSENTIAL FUNCTIONS
• Creates and produces risk adjustment analyses for Risk Score department, senior leadership, internal and external customers
• Utilizes several different risk adjustment calculation and reporting software tools, and is able to merge and analyze data from several different sources
• Completes sophisticated analyses of claims and risk adjustment data using SQL and/or SAS
• Manages the analytic component of complex departmental projects such as vendor-assisted chart reviews and in home medical assessments
• Completes ad-hoc analyses to support internal customers
• Evaluates the accuracy of diagnosis coding and documentation in medical records for audits as well as for identifying common issues that result in either under coding or over coding
• Develops strategies for provider training, education and medical management
• Evaluates data quality of internal and external datasets
• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
• Hold self and others accountable to meet commitments.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships – both internal as well as external.
• Other duties as assigned with or without accommodation.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
Under the direction of the Risk Score Manager, this analyst is responsible for providing primary analytic support to the Risk Score Management program with the objective of improving the accuracy of member risk profiles. This analyst will develop and produce reports based on risk adjustment data from several data sources, work with both internal and external departments to identify opportunities for risk score improvement, and manage multiple risk score projects. This analyst will be responsible for targeted member tracking for medical record audits and outreach, vendor management and provider engagement. This analyst will be required to lead analytic projects with minimal supervision, as well as mentor and train other analysts in both the Risk Score Management department and other departments within the organization that also use the data, such as Medical Economics and Clinical.
ESSENTIAL FUNCTIONS
• Creates and produces risk adjustment analyses for Risk Score department, senior leadership, internal and external customers
• Utilizes several different risk adjustment calculation and reporting software tools, and is able to merge and analyze data from several different sources
• Completes sophisticated analyses of claims and risk adjustment data using SQL and/or SAS
• Manages the analytic component of complex departmental projects such as vendor-assisted chart reviews and in home medical assessments
• Completes ad-hoc analyses to support internal customers
• Evaluates the accuracy of diagnosis coding and documentation in medical records for audits as well as for identifying common issues that result in either under coding or over coding
• Develops strategies for provider training, education and medical management
• Evaluates data quality of internal and external datasets
• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
• Hold self and others accountable to meet commitments.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships – both internal as well as external.
• Other duties as assigned with or without accommodation.
Qualifications
Qualifications
- Bachelor’s degree required or the equivalent combination of training and experience, Master's degree preferred
- At least 5-7 years of experience in data analysis, financial reporting, or risk management
- At least 3-5 years of experience with data analysis tools and software such as SQL, R, Python, or similar
Preferred:
- Prior experience working for a health plan or in a managed care setting
- Experience using query tools such as SQL and/or SAS
- Advanced Excel, Visual Basic, and/or other reporting skills
- Experience and skill working with large, complex datasets
- Experience with risk adjustment data
- Knowledge of procedure and diagnosis coding methods (CPT-4, ICD-9
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