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Risk Adjustment Consulting, Senior
4 months ago
Your Role
The ACA retrospective chart team develops suspecting logic to determine unreported diagnosis in medical charts, tracks retrieval, coding, QA of charts, perform ad hoc analytics to help team monitor expected value of each chart chase and determine drivers of performance.. The Risk Adjustment senior will report to the Sr Manager. In this role you will be a skilled analytic lead that plays a pivotal role in coordinating team efforts and supporting management in analytic projects. You will specialize in addressing questions related to various medical chart attributes that may have unexpected outcomes. You must be comfortable managing large population datasets in SQL/SAS and have familiarity with healthcare data from medical charts, to claims to medical charts to supplemental submissions for ACA Risk adjustment.
Your Work
In this role, you will:
- Analyze information for core principles and functionality of decision, descriptive and predictive analytic methods including forecasting, statistical and machine learning techniques
- Train lower-level analysts on how to update and apply these advanced analytic techniques
- Contribute to successful programs for the team, engaged multiple areas related to vendor oversight, internal cross-functional partnerships, tracking performance and measuring results
- Lead data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals
- Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
- Adept at creating timelines and staying on track on projects. Drive root cause analysis and manage mitigation plans). Provide clear communication with clear takeaways and analytic insights
- Manage complex data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals.
- Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs.
- Assist in generating chart chase lists, manage retrieval of ACA charts with vendor, track chart coding and validations, assist in the preparation of XML submissions to EDG server.
Your Knowledge and Experience
- Requires a bachelor’s degree or equivalent experience
- Requires at least 3 years of professional experience
- Requires experience with ACA or MA Risk adjustment concepts desired
- Requires operational background to manage processes, vendor, and staff.
- Require experience in assessing trends and patterns in a population dataset using SAS / SQL
- Require ability to juggle multiple complex tasks simultaneously and message clearly to dependent party when one task is slipping relative to another.
- Require ability to validate new and existing data analytic processes, in context of broader enterprise objectives
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
Pay Range:
The pay range for this role is: $ 99000.00 to $ 148500.00 for California.
