Risk Adjustment Data Analyst

Health New England Inc   •  

Springfield, MA

Industry: Accounting, Finance & Insurance

  •  

Less than 5 years

Posted 81 days ago

This job is no longer available.

Position Summary The Risk Adjustment Data Analyst is an analytical role that is responsible for supporting Risk Adjustment Department in strategic decision-making through the use of data analysis, interpretation and reporting. Using appropriate industry standard quantitative and qualitative data analysis techniques, the Risk Adjustment Data Analyst serves a variety of internal and external stakeholders, including network providers, PHOs, ACOs and regulatory agencies.

Essential Functions: List in order of importance the essential duties and responsibilities of this role, and estimate the percentage of time spent on each. Include management and supervisory responsibilities, if any.

Data Analysis and Analytical Report Development – 80%
• Analyze complex clinical, financial and quality data sets and communicate coding/auditing trends to Risk Adjustment leadership for the creation of innovative Risk Adjustment strategies
• Develop and implement analytical processes that allow for predictive analytics, trend analyses, variation analyses, and provider profiling.
• Solve business problems through analysis and communicate the outcomes to internal and external stakeholders, business owners and senior management.
• Use industry standard analytical software (e.g. SAS, SSRS, SQL Server, etc.) to develop and implement reports for internal and external stakeholders.
• Consult with internal and external stakeholders to develop business requirements for report development.
• Develop and implement advanced queries.
• Collaborate with IT Data Management staff to ensure the accuracy and appropriate use of all Risk Adjustment related data in the ODS, data extracts and other data sources.
• Maintain proper documentation to support Standard Operating Procedures.

Ad-hoc Analysis and Reporting Support – 20%
• Provide support for ad -hoc clinical, financial, regulatory, pharmacy and operational informational requests.
• Prepare reports and supporting analysis for internal and external stakeholders to review trends, identify patterns in coding and billing, and improve both clinical and financial efficiency from a Risk Adjustment perspective.
• Act as a resource for other members of the department on business issues and identify ways to leverage data and reporting to solve problems identified by the team.


Minimum Requirements Bachelor’s degree with a minimum of 3 years of informatics, analytical processes and reporting development experience in a healthcare setting or an equivalent combination of education and experience.

• Experience with analytical software and languages (SAS and SQL)
• Experience with claims, clinical, and/or financial data
• Experience with data interpretation, analysis and reporting
• Knowledge of managed care and health care claims
• Advanced Microsoft Access and Excel skills
• Excellent oral and written communication skills
• Excellent presentation skills
• Ability to design, evaluate and interpret complex data sets
• Professional Coding certification a plus

R075-18