Manager, Risk Adjustment Analytics
Capital Blue Cross
full-time
Posted on:
Location: Pennsylvania • 🇺🇸 United States
Visit company websiteSalary
💰 $83,800 - $157,890 per year
Job Level
Mid-LevelSenior
Tech Stack
PythonSQL
About the role
- Responsible for the deployment of comprehensive, compliant risk adjustment analytics
- Develop strategies to ensure risk adjustment data accuracy and respond to new requirements from CMS or company leadership
- Coordinate the work of clinical and operations partners and support prospective efforts for member targeting strategies
- Prepare performance reporting and analyze the success of various risk adjustment strategies for Medicare and ACA populations
- Oversee development and ongoing support of key analytics including leading indicators and KPI’s
- Use internal analytics and vendor reporting to identify and monitor member- and provider-facing activities
- Develop and maintain operational reports to assist physicians and evaluate provider performance
- Assess Risk Adjustment programs and vendors via campaign and targeting valuation, year-over-year metrics and initiative-level ROI
- Collaborate with operations to develop analytics for execution and vendor management (chase lists, priority lists, gap lists)
- Work closely with Actuary and stakeholders to supply RAF analytics outputs and ensure correct RAF data utilization
- Conduct in-depth analysis of claims, enrollment and provider coding trends to resolve issues impacting risk adjustment
- Create and maintain dashboards for internal and external reporting
- Serve as Subject Matter Expert for data analytics & reporting related to Risk Adjustment at Capital
Requirements
- Advanced analytical skills, including using SQL or other programming language to query large relational databases
- Experience in building and maintaining reports (Power BI or other reporting tool)
- Proactive communication style and ability to work with a variety of stakeholders
- Expert level understanding of MA and ACA data sets including claims, eligibility, provider and CMS/HHS data files
- Deep understanding of compliance within risk adjustment
- Moderate level knowledge of CMS and HHS Risk Adjustment models
- 5 years of experience in risk adjustment in a Medicare Advantage or ACA environment
- 3 years experience with healthcare data specifically medical claims and/or encounter data
- 3 years experience with SQL, Python or other programming language
- 1 year staff, team lead or project lead experience
- Bachelor’s degree or 9 years experience in healthcare data & reporting in lieu of degree