Senior Risk Adjustment Data Analyst

Job Description

Location : Remote Classification : Full-time, Exempt

Department : Data Analytics Reports to : Senior Director, Data and Analytics

Position Category : Non-Managerial Last Revised : September

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the ClareMedica team is comprised of the brightest and best in their fields of expertise.

From clinical excellence to unparalleled administrative support and beyond, we're working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees' growth and wellness and where their full potential and value are realized.

At ClareMedica, we're excited about great people like you. We're even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits - welcome to ClareMedica.

ESSENTIAL FUNCTIONS :

The Senior Risk Adjustment Data Analyst primary role is to develop reporting and data analysis solutions pertaining to Medicare Advantage / CMS risk models.

They work closely with internal customers and teams to turn data into critical information and knowledge that can be used to make sound business decisions.

Oversees calculation and tracking of risk factors and analyzes trends in risk scores. Performs analysis and makes recommendations for improving risk coding accuracy.

Works with risk adjustment vendor and medical groups to improve risk coding accuracy and submission processes.

DUTIES AND RESPONSIBILITIES :

• Organizes and leads the team responsible for risk score tracking and improvement.
• Maintains internal risk adjustment models using published documentation from CMS.
• Design and create data visualizations, reports and dashboards as required to support operational and clinical areas.
• Build datasets that can be utilized by reports and visualizations to support productivity and production key metrics.
• Collaborate with users to identify data needs and business metric definitions.
• Trains users to transform data into action-oriented information and to use that information correctly.
• Directs, organizes, and leads BI workstream projects in the implementation and use of new BI software tools and systems.

SUPERVISORY RESPONSIBILITIES

This position does not have supervisory responsibilities.

QUALIFICATIONS / REQUIREMENTS

• Bachelor's degree in computer science, Mathematics, Business Management or specialized training / certification or equivalent work experience
• 3 years of report and analysis design and development experience
• Experience querying data directly from a data warehouse.
• Proven ability to improve processes, be proactive, and take initiative.
• Enthusiastic about data, data visualization, and data science
• Strong analytical, quantitative, problem solving, and organizational skills; attention to detail; and ability to coordinate multiple tasks, set priorities, and meet deadlines.
• Strong written and verbal communication skills
• Ability to collaborate with key team members and subject experts.
• Intermediate to advanced Excel skills including data manipulation, data cleansing, and data blending.
• 3 years' experience with various risk adjustment models including the CMS Medicare HCC models, v24 and v28; includes MAO-, MAO-, MMR, MOR, and file expertise.
• 3 years' experience with Electronic Medical Records systems and / or
• 3 years' experience with medical economics (claims, utilization, HCC / RAF)
• Microsoft PowerBI report design including dashboards, reporting, and front-end visualizations.
• SQL Server programming experience (SSMS)
• Familiarity with Population Health applications
• Experience with full life cycle of development in a BI or Analytics environment.
• Python and SSIS programming experience is a plus.

WORKING CONDITIONS

General office working conditions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

• While performing the duties of this job, the employee will be required to stand / walk for extended periods of time; sit;
• use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl;

talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus.

Manual dexterity is required to use desktop computers and peripherals.

WORK ENVIRONMENT

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

TRAVEL

Travel is not required for this role.

SAFETY HAZARD OF THE JOB

Minimal Hazards

This job description does not list all the duties and responsibilities of the job. You may be asked by supervisors or managers to perform other instruction, duties, and responsibilities, as appropriate.

You will be evaluated in part based upon your performance of the duties and responsibilities identified in this job description.

Management has the right to revise this job description at any time. The job description is not a contract for employment, and either you or the employer may terminate employment any time, with or without cause.

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Last updated : 2024-07-02