Risk Adjustment Consulting, Experienced

Your Role

The Risk Adjustment Retrospective Analytics team focuses on delivering complete and accurate analytics for Prospective and Retrospective suspecting, financial impact calculations, and data submission. The Risk Adjustment Analyst, Experienced will report to the Manager of Risk Adjustment Analytics. In this role you will develop and refine Risk Adjustment Suspecting logic, quantify the financial impact of the Risk Adjustment programs, and support complete and accurate data submission for both Medicare Advantage and ACA Chart Review Programs.

Your Work

In this role, you will:

• Analyze under the supervision of the core principles and functionality of decision and descriptive analytics including analyzing historical data, past performance and trends 
• Develop and run programs that apply to decision analytic techniques
• Contribute to successful programs for the team, engaged in typically one area related to vendor oversight, internal cross functional partnerships, tracking performance and measuring results
• Continuously learn about plan data including claim, premium, membership, and risk score assignment 
• Conduct data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports
• Experience with HHS-Developed Risk Adjustment Model Algorithm for the Medicare Advantage and Commercial markets preferred 

Your Knowledge and Experience
 

• Requires a bachelor's degree in mathematics, statistics, computer science or related field or equivalent business experience

• Requires at least 3 years of professional experience in healthcare preferably in risk adjustment or actuarial

• Requires practical knowledge of job area obtained through professional experience and advanced education

• Requires proficiency with MS Office, including Excel, Word, PowerPoint 

• Familiarity with SQL, SAS, R, Python or other data analysis tools strongly preferred

• Prior exposure to claims data, membership data, premium data, and risk score assignment processes strongly preferred

• Excellent communication and presentation skills with the ability to translate complex information to cross-functional teams (e.g., vendor management, product, finance, compliance)