Professional, Risk Adjustment Analyst
MVP Health Care is on a mission to create a healthier future for everyone, emphasizing innovation and equity in health care. They are seeking a Professional Risk Adjustment Analyst to perform analytics and reporting on various member populations, focusing on Risk Adjustment efforts and improving health care delivery.
Responsibilities
- You will be 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 across
- 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
- Calculates ROIs for Risk Adjustment programs
- Maintain regulatory agency requirements for CMS and NYS related to supplemental data
- Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer
Skills
- Bachelor's Degree 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
- Competitive compensation and comprehensive benefits focused on well-being
Company Overview