Principal Healthcare Risk Adjustment Data Analyst
1 month ago
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is This Role Important to Our Work?
This position will support Enterprise Risk Adjustment (ERA), a Stella Program responsible for optimizing risk adjustment revenue through closing gaps and risks in coding and care delivery across Blue Cross' Medicare, Medicaid, and ACA populations. Specifically, this position is responsible for business intelligence and analytics related to Enterprise Risk Adjustment. The applicant will achieve success using a combination of traits and skills including industry knowledge of risk assessment and risk adjustment knowledge domains, data and programming savvy, math and statistical abilities, and a spirit of creativity and problem-solving to deepen insights into the factors that drive health care quality and risk adjustment outcomes. A successful applicant will work independently as well as collaboratively with cross-functional teams to initiate, plan, and lead analysis from conceptual development to conclusion. The position will lead efforts with coworkers, internal business partners, and leadership to clarify requirements, analyze complex data, and produce and present meaningful and defensible results, including the identification of success factors and barriers, improvement opportunities, proposing solutions, and informing strategic decisions. The individual will also drive action based on the results obtained. The Risk Adjustment Data Analyst Pr will represent the department on both internal and external initiatives. They may also lead project teams. The incumbent will lead efforts to define meaningful contributions that will influence strategic decision-making and the optimization of Stars/Risk/Quality analytics at Blue Cross Blue Shield of Minnesota.A Day in the Life:
Uses databases for analysis and dissemination of information.Performs complex analysis of data.Researches, analyzes data, applies statistical methods when appropriate, and provides interpretation of outcomes.Identifies issues to be researched, determining affected areas, estimating the impact and contributing to the resolution.Leads teams to develop analytic approaches, measurement plans, data analysis, and report results on health care utilization, expenditures, outcomes, and benchmarks.Initiates actions to discover new analyses that will contribute to the strategic needs of Blue Cross Blue Shield of Minnesota.Works with leadership to understand and interpret the impacts to cost and quality of proposals using relevant data sources and analytic methods.Helps drive the implementation of new products and systems by providing actionable information and recommendations that evaluate the impact of the proposed products and systems.Represents the division on corporate projects and may have leadership roles on these teams.Independently manages issues that may arise on multiple tasks or projects with limited or no management involvement.Acts as a resource and/or mentor for other members of the department and company on business issues and may be responsible for training and guidance of other employees.Formulates strategic recommendations and present findings to management and external clients.Serves as an analytic consultant who can explain complex measurement or analysis techniques and results in layman's terms.Nice to Have:Bachelor's Degree or Master's degree or ASA/FSA preferred. Knowledge of managed care and healthcare claims preferred.Knowledge of Tableau or other data visualization software preferred, with expertise or an interest in developing programming skillsDemonstrated understanding of predictive & regression model development and application to risk adjustment.Experience in data science model development and maintenance (e.g. feature engineering, logistic regression, decision trees, testing/validation)Required Skills and Experiences:7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.Knowledge & understanding of risk adjustment in healthcare including common risk adjustment models (e.g. CMS-HCC, HHS-HCC, CDPS)5 years experience analyzing and modeling data involving outcomes and utilization, using various statistical software and computer programming (SAS, SQL, R, Python, etc.).Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.Demonstrated ability to design, evaluate and interpret complex data sets.Demonstrated ability to handle multiple tasks with competing priorities.Demonstrated analytic and problems solving skills.Excellent written and verbal communication skills, with the ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers.Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/clinical.Make A DifferenceBlue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
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Eagan, Minnesota, United States Blue Cross and Blue Shield of Minnesota Full timeAbout Blue CrossBlue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.This position is posted at a hierarchy and can be hired at either the Senior...
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Eagan, Minnesota, United States BlueCross BlueShield of Minnesota Full timeAbout Blue CrossBlue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.This position is posted at a hierarchy and can be hired at either the Senior...
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Eagan, Minnesota, United States Blue Cross and Blue Shield of Minnesota Full timeAbout Blue CrossBlue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.This position is posted at a hierarchy and can be hired at either the Senior...
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