Senior Risk Adjustment Data Analyst

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Qhov chaw: Chaw taws teeb; California

We have an opportunity to join the Alliance as a Senior Risk Adjustment Data Analyst in the Risk Adjustment Department. 

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Reporting to the Risk Adjustment Director, this position will perform complex analytical data mining and reporting in support of the Risk Adjustment Department.  You will also lead initiatives, provide program support, and perform project management related to data gathering and analysis as well as act as a subject matter expert and resource regarding risk adjustment data.

HAIS TXOG TEAM

Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan.  Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs.  We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment.

LUB IDEAL CANDIDATE 

• Well versed in risk adjustment methodologies, particularly within the Medicare space
• Familiarity with risk adjustment models and their impact on plan performance and payment
• Proficiency in SQL, and an ability to analyze and translate complex healthcare data into meaningful and actionable insights, in addition to general reporting
• Experience with data visualization tools to present insights clearly and effectively
• Self-directed and proactive, with the ability to manage priorities and drive projects forward
• Strong collaborator who can work effectively with organizational teams, including IT, finance, operations, clinical and compliance teams
• Medicaid/Medi-Cal experience a plus

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• Kev paub txog:
• Quantitative data analysis methodologies and analytical tools related to risk adjustment reporting and analysis
• Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
• Medicare program and related regulations
• Medicare (Hierarchical Condition Categories) risk adjustment models
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  • Perform technical and non-technical troubleshooting and diagnose and resolve complex problems, including problems that may have multiple variables and may not have obvious solutions
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• Kev Kawm thiab Kev Paub:
  • Bachelor’s degree in Finance, Business, Information Technology, or a related field
  • A minimum of five years of experience performing health care finance reporting and analytics, including a minimum of three years of experience working in a Medicare environment (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.

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Cov cheeb tsam uas nyob rau thaj tsam 1: Bay Area, Sacramento, Los Angeles cheeb tsam, San Diego cheeb tsam

Tej thaj chaw uas nyob rau thaj tsam 2: Fresno cheeb tsam, Bakersfield, Central Valley (tshwj tsis yog ntawm Sacramento), Eastern California, Eureka cheeb tsam

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