SCOPE OF ROLE The Risk Adjustment and Analytics Team is working to push boundaries to redefine Risk Adjustment and Quality Analytics in a Value-Based Care Setting. The Risk Adjustment Analyst will be the lead in the design, implementation, and maintenance of all Risk Adjustment and Quality Data and Dashboards for our entire NeueHealth Portfolio: ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as Analytics, Risk Adjustment and Quality, Medical Economics, & Clinical Operations.
This is an onsite position in Doral, FL.
ROLE RESPONSIBILITIES- Proactively collaborate and interact with business stakeholders across the organization to understand analytics needs, develop plans to address those needs, and deliver analytics to meet those needs.
- Using SQL code, mine data on medical spend, clinical data and population health data and derive meaningful insights to improve operations such as trends, correlations and patterns.
- Own the data. You are responsible for accurate presentation of your data elements, so ensuring data integrity is paramount.
- Thoroughly analyze data, quickly identify relevant information, and transform it into a meaningful output. Conduct thoughtful presentations, online or in person, to stakeholders with actionable findings for improvement.
- Provide concise data reports and clear data visualizations for executive level reporting through Power BI, Excel and other tools used by the organization.
- Create data processes that are consistent, repeatable, and scalable.
- Conduct Quarterly Reconciliations to identify dropped HCCs and prepare supplemental data submission files according to payor partner specifications.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE- Bachelor's degree is required.
- Comprehensive understanding of risk adjustment and quality programs across all government-regulated lines of business, including Marketplace, Medicaid, and Medicare programs.
- Five (5) or more years of hands-on SQL code development is required, including expertise with programming languages like Scala or Python.
- Three (3) or more years of experience in healthcare field dealing with claims/utilization as it pertains to Risk Adjustment and Quality.
- Three (3) or more years of analytics experience (Required)
- Two (2) or more years of Power BI experience (Required)
- Experience with Databricks (Preferred)
- Familiarity with CMS-HCC and HHS-HCC risk Adjustment Models
- Familiarity with HEDIS and MSSP Quality Reporting
PROFESSIONAL COMPETENCIES- Expertise in analytics, statistics, data visualization, or programming
- Dedicates exacting attention to detail and data quality
- Eager learner, collaborative partner, easy communicator, and careful analyst
- Passion for empirical research and answering hard questions with data
