Develop and maintain data processes and analytics related to the Centers for Medicare & Medicaid Services (CMS) -Hierarchical Condition Categories (HCC) risk adjustment model for the Medicare population
Ensure that risk scores are accurately calculated and all updates from CMS are applied to the CMS HCC Risk Adjustment model
Use a suite of tools to implement risk score calculation, develop actionable insights, develop risk score forecasts, and create dashboards/reporting, and optimize existing processes
Calculate risk scores for each Honest member using CMS HCC risk adjustment model and maintain model to account for any changes made by CMS
Develop SQL processes to automate risk score runs that integrate data from a multitude of datasets
Evaluate project performance and identify value drivers for risk adjustment initiatives and programs
Develop processes to calculate and automate key performance indicator (KPI)’s specific to risk adjustment as well as effectively communicate KPI’s to internal stakeholders
Work closely with internal teams (Actuarial, Health Economics, and Finance) to provide data and insights necessary for financial forecasts and projections
Build risk adjustment dashboards and automated reporting in Tableau for internal and external stakeholders
Work closely with performance management and reporting teams to provide data and reporting necessary for practice and provider scorecards
Perform other related responsibilities as assigned
Requirements
Bachelor's degree in analytics, computer science, engineering, economics, or a related quantitative field required
Master’s degree in analytics or computer science is considered a plus
Advanced data manipulation skills with 3+ years of SQL experience
3+ years of data analytics experience delivering actionable insights
Advanced MS Excel skills with 3+ years of experience
Experience working with large healthcare datasets strongly preferred
Experience using data visualization software (Tableau or Power BI) to build automated reporting and dashboards