Risk Adjustment Data Modeller - The Centrics Staffing Group
Alpharetta, GA
About the Job
The Sr. Risk Adjustment Data Modeler will be primarily responsible for risk adjustment modeling and analysis for Medicare, ACA, & Medicaid populations, but may also be required to develop or complete other healthcare data analysis. To succeed in this role, you should be analytical, resourceful, and have a complete understanding of Medicare Advantage ACA, Medicaid, Risk Adjustment models, and concepts. You should also be an excellent oral and written communicator who is able to tell the story behind raw data to non-technical audiences.
Responsibilities
Develop and maintain risk adjustment calculation engines using appropriate data sources and software
Create standard Risk Adjustment analysis and metrics, such as same -store analysis, incremental lift, gap analysis, and HCC/code recapture.
Interpret CMS Advance Notices, and Federal Register documentation
Analyze/Clean/Load/Stage payer data from disparate sources into centralized data marts
Delve into data to discover discrepancies and patterns
Present and explain information analysis in an accessible way to internal stakeholders and external partners
Collaborate with management and internal teams to implement and evaluate improvements.
Analyze enrollment/eligibility, claims or other health plan data.
Requirements
Expert knowledge of CMS-HCC, HHS-HCC and risk adjust models
Familiarity or working knowledge of state-specific CDPS Medicaid models.
BSc/BA in Health Informatics, Statistics, Mathematics, Actuarial Science, or a related field preferred
2-3+ years proven experience as a Healthcare Data Analyst (Emphasis on Risk Adjustment Calculations)
2-3+ years of experience in data analysis and BI Software (Tableau, Power BI, SSRS)
3+ years’ experience writing SQL preference for MS T-SQL, SQL Server, and SSMS
Experienced in executing SAS-based Risk Adjustment modeling desired
Ability to work in a fast-paced environment with minimal direction
Knowledge of Extract, Transform and Load (ETL) processes
Experience with Enterprise Data Warehouse (EDW) and data management systems
Excellent analytical and communication skills
Outstanding organizational and problem-solving aptitude
Responsibilities
Develop and maintain risk adjustment calculation engines using appropriate data sources and software
Create standard Risk Adjustment analysis and metrics, such as same -store analysis, incremental lift, gap analysis, and HCC/code recapture.
Interpret CMS Advance Notices, and Federal Register documentation
Analyze/Clean/Load/Stage payer data from disparate sources into centralized data marts
Delve into data to discover discrepancies and patterns
Present and explain information analysis in an accessible way to internal stakeholders and external partners
Collaborate with management and internal teams to implement and evaluate improvements.
Analyze enrollment/eligibility, claims or other health plan data.
Requirements
Expert knowledge of CMS-HCC, HHS-HCC and risk adjust models
Familiarity or working knowledge of state-specific CDPS Medicaid models.
BSc/BA in Health Informatics, Statistics, Mathematics, Actuarial Science, or a related field preferred
2-3+ years proven experience as a Healthcare Data Analyst (Emphasis on Risk Adjustment Calculations)
2-3+ years of experience in data analysis and BI Software (Tableau, Power BI, SSRS)
3+ years’ experience writing SQL preference for MS T-SQL, SQL Server, and SSMS
Experienced in executing SAS-based Risk Adjustment modeling desired
Ability to work in a fast-paced environment with minimal direction
Knowledge of Extract, Transform and Load (ETL) processes
Experience with Enterprise Data Warehouse (EDW) and data management systems
Excellent analytical and communication skills
Outstanding organizational and problem-solving aptitude
Source : The Centrics Staffing Group