Data Analyst, Risk Adjustment Specialist

7 days ago


Canton, Massachusetts, United States Point32Health Full time
Job Summary

Point32Health is seeking a highly skilled Data Analyst to support the operations and analysis of risk adjustment strategy across our business lines. As a Data Analyst, you will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and synthesizing results to develop insights, developing provider group reports, and evaluating vendor and program performance.

Key Responsibilities
  • Data Analysis
    • Support program reporting by developing and maintaining program dashboards, reports, and deliverables for internal leadership and external provider organizations.
    • Extract, transform, and analyze healthcare data from various internal data systems (Oracle, SQL Server, and Teradata) using SAS and SQL knowledge to support risk adjustment initiatives.
    • Work with internal claims, provider, member data, and external analytics vendors to independently perform opportunity analyses across business divisions, product lines, and provider groups.
    • Support the program management team in reviewing data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement, and opportunities to management.
  • Data Management
    • Establish and manage data transfer methods with vendors, including working with IT to set up and manage secure file transfer sites for vendors that support our risk adjustment programs.
    • Manage all incoming data from program operations, perform quality checks, and disseminate to various stakeholder groups as appropriate.
    • Maintain an organized structure for all incoming data, operational reporting, and program communications. Develop and manage policies and procedures associated with these work efforts.
  • Program Management
    • Support the implementation, operations, and evaluation of risk adjustment programs across Point32Health's Government business, support Commercial business as needed.
    • Coordinate program operations with various other internal departments, including select member referrals and/or grievances.
    • Support program close-out and evaluation of vendor and program performance for programs implemented to optimize risk score accuracy for the Government business and Commercial business as necessary.
  • Project Management
    • Provide implementation support for risk adjustment vendor implementation and operations related to key data deliverables and requirements.
    • Take ownership of key tasks associated with program operations such as managing operational and status updates, including but not limited to the collection, organization, and distribution of all incoming risk adjustment program data.
    • Create, compile, and format presentations for a variety of audiences. This includes the supporting worksheets, graphics, supplemental documents.
  • Administration
    • Attend meetings, document key decisions, manage follow-up actions as necessary.
    • Serve as department point of contact for various internal and external initiatives, including interdepartmental projects across Point32Health business lines.
    • Create and manage business policies and procedures and knowledge repositories for the department as needed.

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