Senior Clinical Healthcare Analyst - Risk Adjustment
Location: Steward Health Care Network
Posted Date: 5/18/2023
The Senior Analyst will support the risk adjustment optimization efforts of the Steward Health Care Network (SHCN) with emphasis on Commercial and Medicaid risk contracts. The Senior Analyst will demonstrate strong technical skills, knowledge of key performance indicators and a track record of delivering actionable data and key business insights.
- Performs all data and analytic functions required for risk adjustment model building; financial impact analysis will evaluate new government guidelines, methodology changes and program operations.
- Collaborates with finance and contracting teams to advance Commercial and Medicaid business development strategies
- Delivers accurate and on-time deliverables, including supplemental submissions, operations and financial reports, predictive models, and ad-hoc analysis
- Calculates ROI for risk adjustment vendor arrangements
- Maintains current knowledge of CMS Medicare HCC, CDPS and CMS HHS HCC risk adjustment models; and develops strong working knowledge of common industry models such as DxCG, ACG and Milliman MARA.
- Provides insightful interpretations and gaps in medical claim reconciliation to both SHCN national leadership and regional operations leads.
- Responsible for risk adjustment metrics generated for provider engagement scorecards
- Produces SHCN Close reporting exhibits to demonstrate the operations progress and financial impact SHCN Risk Adjustment/ Quality programs
- Respects the confidential and sensitive nature of patient health information, maintaining the highest degree of compliance to internal and national governing regulations
Years of Experience:
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Job Status: Full Time
Job Reference #: 130124