Manager Data Risk Adjustment from System One
Houston, TX 77030
About the Job
System One is working with a large health insurance organization that is seeking a qualified Manager level candidate to oversee their Data Risk and Analytics team. This individual will have direct responsibilities to conduct and oversee risk assessment and data analytics to ensure compliance and quality are adhered. Individuals with experience in healthcare or insurance industries as well as possessing a degree in Mathematics, Actuarial Science, Economics, or Statistics is preferred. This position is a permanent, full time opportunity offering full benefits, PTO and robust retirement plan packages. While it is preferred the person relocate to the Tulsa, Oklahoma area, there is an opportunity for this to be a remote role based on availability for the candidate to travel on site as needed.
Responsibilities:
Responsibilities:
- Organizes and leads the team responsible for risk score tracking and improvement.
- Maintains internal risk adjustment models using published documentation.
- Manages projects including creating and leading a team of analysts, interaction with other departments and outside parties. Perform quality review of work product produced by assigned analysts.
- Conducts major analytical projects without immediate supervision including all aspects from programming to analyzing and abstracting information into written reports and possible oral presentation.
- Oversees training of new analysts and professional development of supervised analysts.
- Supervises and performs advanced analytical modeling. Oversees provider contract modeling.
- Facilitates submission of encounters to regulatory agencies.
- Oversees other data submission to regulatory agencies.
- Performs other duties as assigned.
- Ability to conduct concurrently multiple analyses without immediate oversight.
- Ability to manage multiple projects including creating and leading a team of analysts, interaction with other departments and outside parties.
- Ability to apply advanced actuarial, mathematical and statistical techniques and principles into the analysis of financial and health related data.
- Possess strong oral and written communication skills.
- Successful completion of Health Care Sanctions background check.
- Proficient in Microsoft Office applications.
- Bachelor’s degree in Mathematics, Statistics, Economics, Actuarial Science required.
- Proficiency in SAS, SQL, or other analytical software.
- 6 plus years analytical experience; preferably in a managed care or healthcare environment.
- 4-6 years of management experience strongly preferred.
- Experience with various risk adjustment models including the CMS Medicare model, CMS ACA Model and 3rd party software strongly preferred.