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Risk Adjustment Data Analyst I/II/III/IV

2 months ago

Buffalo, United States Univera Healthcare Full time
Job Description:

Summary:

The Risk Data Analyst gathers, standardizes and consolidates financial claims, membership, clinical and premium data into data sets that are used for various reporting, analytical, and actuarial needs and submission to regulatory agencies to support Risk Adjustment. This position interacts with analytical staff in all regions, Federal and State regulators, and external vendors to gather requirements necessary to construct data sets, maintains monthly responsibilities for updates to data sets and handles requests for additions or changes to submission files and reporting needs. At the higher levels, the position extracts, transforms and loads financial claim, membership, clinical and premium data into data sets/tables, data repositories and data warehouses that supply management, external vendors, and internal departments with (1) the statistical information needed to make corporate decisions, (2) data required for predictive & advanced analytics, and (3) the development of financial forecasts and reserving.

Essential Primary Responsibilities/Accountabilities:

Level I:
  • Gathers, standardizes and consolidates financial claims, membership, clinical and premium data into data sets that are used by Risk Adjustment and Actuarial analysts for various analytical and reporting needs including: (1) encounter submission, (2) pricing and product information, (3) trend reporting, (4) corporate and regulatory audits, (5) risk adjustment risk scoring, (6) risk adjustment operations (7) predictive modeling and (8) forecasting, reserves, and financial reporting.
  • Coordinates with IT administrators to ensure data access for Risk Adjustment staff, monitors staff usage, and schedules data jobs.
  • Monitors and responds to requests for additions or necessary changes to data sets.
  • Prepares reporting based on analysis of current encounter submission and acceptance.
  • Develops ad hoc reports to supplement Risk Adjustment processes through query building and data extraction and analysis.
  • Assists and/or supports other Risk Adjustment teams or Health Plan departments to complete projects or tasks as needed.
  • Participates in ongoing training for analytic and business intelligence tools.
  • Participates on departmental and Health Plan project teams as needed.
  • Accountable for loading monthly databases, updating hand-managed tables, and maintaining code that generates the information contained in those databases and tables.
  • Supports ad hoc requests as needed. Performs or aids Risk Adjustment in the development of basic programs using data integration programming languages and tools.
  • Performs necessary statistical, analytical, and operational support in the submission of federal and state regulatory filings for Risk Adjustment operations.
  • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Performs other functions as assigned by management.

Level II (in addition to Level I essential responsibilities/accountabilities):
  • Assists in ad hoc projects in support of Actuarial, Finance, Value Based Payments, Information Technology, Analytics and Data, Compliance, and other departments.
  • Performs advanced programming and statistical analysis/support for ad hoc requests.
  • Acts as a contact for internal project teams or external vendors for supporting standard operational work.
  • Proposes and assists in development of process improvements and automation of processes utilizing data integration software.
  • Identifies and develops corrective action with regard to Data Warehouse integrity issues.
  • Initiates and leads efforts to continually improve data capabilities and quality of department analysis and reporting.
  • Participates in ongoing training and development for analytic and business intelligence tools.

Level III (in addition to Level II essential responsibilities/accountabilities):
  • Works with Risk Adjustment staff to scope out new requirements for data and/or systems and develops either a plan to incorporate data into the new or existing databases or a process to meet their needs.
  • Subject matter expert for assigned work and tasks, both internal and external.
  • Trains new users of corporate data integration tools and/or works with existing users to transition work over to data integration programs or improve the performance of current programs/projects.
  • Facilitates and educates on existing processes for cross training and business continuity purposes.
  • Provides effective technical advice and support to assist management in meeting corporate goals and identifying strategy. Involves other departmental areas as needed.
  • Fosters an environment of continuous improvement. Constantly explores ways to increase efficiencies and productivity, reducing waste, and reducing costs.

Level IV (In addition to Level III responsibilities):
  • Provides decision support and performs data mining functions to identify trends or other analytics in the data.
  • Responsible for defining the business processes, policies and application requirements, and identify required work and tasks, to be able to act as a Business Lead in projects both internal and external.
  • Interacts with Health Plan leadership to create predictive models using information obtained from mining or analysis.
  • Works with new data users in Risk Adjustment to provide introductory training and support using the suite of corporate data integration and analysis tools. Proactively identifies and diagnoses data issues and brings those to appropriate contacts within Risk Adjustment or the wider Health Plan to bring about correction and resolution.


Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels:
  • Bachelors degree in Math, Economics, Actuarial Science, Computer Science, general Sciences or allied field
  • Minimum of one year relevant experience required OR in lieu of experience, actuarial exams or technical certifications or programming course work are required.
  • Desire to participate in Actuarial Study Program, pursue SAS Certification or related career path preferred.
  • Exceptional analytical skills.
  • Focused on meeting the expectations and requirements of both internal and external customers.
  • Knowledge of financial and risk health arrangements.
  • Self-motivation, initiative, and an ability to perform under pressure with little supervision.
  • Strong PC skills including Microsoft Office Suite, (Excel, Access, Word, PowerPoint, Outlook, Teams) and moderate proficiency in data integration tools, such as SAS, SPSS, R, PowerBI, Tableau, etc., required.
  • Experience with programming languages such as base SAS, SQL, R, Python, C, C++, C#, Java or similar languages.
  • Strong verbal and written communication skills.
  • Understanding of basic principles and design of data warehousing.

Level II (in addition to Level I minimum qualifications):
  • A minimum of:
  • Three years risk adjustment or related industry experience required; OR
  • Two years risk adjustment or related industry experience and two actuarial exams is required.
  • 2 years of experience with data integration tools and/or programming languages. SAS Base Certification preferred.
  • Knowledge and understanding of HHS-HCC, CMS-HCC or CRG Risk Adjustment Models.
  • Intermediate SAS programming or equivalent programming language proficiency and experience with data integration and Business Intelligence tools.

Level III (in addition to Level II minimum qualifications):
  • A minimum of:
  • Six years Risk Adjustment or related industry experience required & SAS Base Certification; OR
  • Six years risk adjustment or related industry experience & 5 years data integration or programming experience; OR
  • Three years risk adjustment or related industry experience and four actuarial exams.
  • Advanced SAS programming or equivalent programming proficiency and experience with data integration & Business Intelligence tools required.
  • Project Management/Process Improvement knowledge preferred.

Level IV (in addition to Level III minimum qualifications):
  • A minimum of:
  • Ten years Risk Adjustment or related industry experience required & SAS Advanced Certification; OR
  • Ten years risk adjustment or related industry experience & 8 years data integration or programming experience; OR
  • Six years risk adjustment or related industry experience & a Master's degree in Data Science, Computer Science, Statistics or related fields; OR
  • Five years risk adjustment and 5+ actuarial exams or a combination of actuarial exams and SAS Certifications.
  • Experience with advanced data integration techniques (data mining, predictive modeling, forecasting, macroing, etc.) required.
  • Project Management or Process Improvement knowledge required


Physical Requirements:
  • Position requires working primarily from a desk.


The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade 206: Minimum $56,534 - Maximum $93,267

Level II: Grade 207: Minimum $60,070- Maximum $111,114

Level III: Grade 208: Minimum $67,538 - Maximum $124,925

Level IV: Grade 209: Minimum $75,816 - Maximum $140,254

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.