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Senior Data Analyst, Risk Adjustment Specialist

1 month ago

Canton, Ohio, United States Point32Health Full time
Job Summary

As a Senior Data Analyst, Risk Adjustment, you will play a critical role in supporting the operations and analysis of risk adjustment strategy across Point32Health business lines. Under the oversight of the Senior Manager of Consulting and Operations, 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: Extract, transform and analyze health care data from various internal data systems (Oracle, SQL Server, and Teradata) using SAS and SQL knowledge to support risk adjustment initiatives.
  • Support program reporting by developing and maintaining program dashboards, reports and deliverables for internal leadership and external provider organizations.
  • 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 setup 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 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.
Qualifications
  • Bachelor's degree required, preferably in related field such as health informatics, business analysis, IT, finance, decision modeling.
  • Three to five years of experience in analytical roles in the health care or health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm.
  • Understanding of claims systems, provider information, Medicaid/Medicare, and/or experience working with large data sets preferred.

Point32Health is committed to making diversity, equity and inclusion part of everything we do-from product design to the workforce driving that innovation.