Responsible for performing analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations
Provide analytical support on various prospective and retrospective objectives in population health management including focus on Risk Adjustment efforts
Design targeting based upon disparate data sources to identify members with likely risk gaps
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
Calculate ROIs for Risk Adjustment programs
Maintain regulatory agency requirements for CMS and NYS related to supplemental data.

Requirements

Bachelor’s Degree in Health Administration, Business, Economics, Health Informatics, or related field
1 year experience in a health insurance or 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
Demonstrated problem-solving and analytical abilities along with proven ability to analyze, report and provide insight on large sets of data
Intermediate SQL skills
Ability to manage multiple projects and produce results within deliverable timelines and 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
Data visualization skills (Tableau, Power BI, etc.)
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction.

Benefits

Growth opportunities to uplevel your career
A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
Competitive compensation and comprehensive benefits focused on well-being
An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

analyticsreportingRisk Adjustmentdata analysisSQLdata visualizationfinancial analysiscodingROI calculationpopulation health management

Soft Skills

problem-solvinganalytical abilitiesproject managementcommunicationcuriosityteamworkcommitment