Senior Stars & Risk Adjustment Analyst at CareFirst BlueCross BlueShield in Baltimore, MD

Supports Risk Adjustment & Stars organization to optimize Risk Adjustment revenue and coding accuracy through data-driven approach to closing gaps and risks in coding and care delivery across Medicare & Medicaid populations. Responsible for developing performance monitoring reports and analytics related to Risk Adjustment & Stars programs and processes.

ESSENTIAL FUNCTIONS

Weight Essential Functions

Develops and works with structured data from multiple sources such as HEDIS, CAHPS, Stars and Risk Adjustment related performance and benchmark data. Interprets data, analyzes results using statistical techniques, and provides ongoing reports.

Designs, manages, and conducts review of Risk Adjustment & Stars program data sets using data from multiple systems. Produces regular and adhoc report for business stakeholders to monitor and track Risk Adjustment and Stars performance metrics and enable Risk Adjustment optimization.

Uses business intelligence, statistical, and/or data science techniques to analyze data to evaluate the efficacy of Risk Adjustment & Stars activities (HEDIS, CAHPS, Health Outcomes Survey, Operation & Accurate Risk Optimization initiatives).

Collaborates with third party vendors and internal stakeholders including Stars/Quality, Finance and Actuarial areas to optimize Risk Adjustment performance, accurate coding and drive overall quality of care.

Establishes standards with IT and Data Services teams. Represents the Stars/Risk Adjustment team during enterprise prioritization sessions.

SCOPE

People Management

# of Direct Reports:

# of Indirect Reports:

Individual Contributor Details Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

Financial Responsibility

Budget Responsibility

Amount Notes

Freedom To Act

Work is accomplished with limited direction. Determines and develops approach to solutions. Work is evaluated upon completion to ensure objectives have been met.

Problem Complexity and Problem Solving Timeframes

Provides resolution to an assortment of problems that are typically well defined, but some clarification or judgment is required to determine action, as additional information about the problem / task is discovered. Uses judgment within defined practices / procedures to determine appropriate action. Problem/Task resolution timeframe: Inclusive of shorter timeframes, but the majority of tasks take up to several weeks to resolve.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: Bachelor's Degree

Education Details: Data Science, Mathematics, Computer Science, Statistics, Business or related field

Experience: 5 years experience in Risk Adjustment/Quality/Stars departments with a data visualization and performance monitoring role

4 years of relevant work experience is required in addition to the required work experience.

Knowledge, Skills and Abilities (KSAs) Proficiency

Strong Risk Adjustment & Stars knowledge. Proficient

Strong quantitative and qualitative skills. Advanced

Knowledge and understanding of analytical & data visualization tools, such as Power BI, SAS, Excel, SQL. Proficient

Excellent communication skills both written and verbal Advanced

Ability to learn quickly and take direction. Advanced

Department

Department:

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.