About Our Company
This is Veradigm: Real-world insights with the power to improve real-world health and healthcare.
Job Description & Responsibilities
The Senior Risk Adjustment Analyst will assist our organization as a subject-matter-expert in Medicare Advantage and Affordable Care Act (ACA) Risk Adjustment by developing requirements for new analytics and data products, creating customer financial calculations and projections, and researching customer questions regarding their risk adjustment performance.
- Develop business cases and requirements for new products and current product enhancements that will benefit our customers risk adjustment goals.
- Lead customer requests for ad hoc reporting or research.
- Own customer financial improvement modeling (examples include: Mid Year Payment, Final Year Payment, Transfer Payment).
- Lead research initiatives to monitor our internal algorithm performance over time and recommend future enhancements.
- Collaborate with clinicians in outcomes, algorithm performance, and new product development.
- Provide training and guidance to internal and external customers on all facets of the Risk Adjustment process, from initial data capture at point-of-care, through acceptance to CMS, and successfully validated through audit.
- Research and maintain awareness of CMS regulatory guidance and changes, providing expert interpretation for impacts to products and customers.
- Bachelor’s degree in actuarial science, Math, Statistics, or in a related field of study
- 3 to 5 years of experience analyzing and interpreting Medicare Advantage or Affordable Care Act Risk Adjustment data
- Experience supporting the development of scalable analytic and reporting solutions
- Up to 10% travel may be required
Knowledge, Skills And Abilities
- Extensive experience in healthcare industry, with a focus on Risk Adjustment
- Experience with MA/ACA Risk Scoring methodology, including familiarity with condition categories (HCC)
- Experience with actuarial or financial modeling concepts
- Experience interacting with large amounts of healthcare data; directly with the following CMS files (MMR, MOR, MAO-004, MAO-002, EDGE RARSD, EDGE RATEE)
- Experience working with clinical classification such as diagnoses (ICD), procedures (HCPCS, CPT) and claims processing
- Experience working with data to and from submission systems (RAPS, EDPS, Edge), including background on filtering logic for each system
- Experience with MA mid-year and final year projections (MYRA, FYRA) and/or ACA transfer payments
- Advance knowledge of SAS and experience with SQL
- Working knowledge of statistics with ability/interest to become proficient
- Proven technical, analytical, detail oriented, and problem solving
- Strong written and verbal communication
- Professional and interpersonal
- Self-initiative and leadership
- Ability to work within a team environment
- Ability to interface with both external and internal personnel at all levels.
What we offer
In compliance with the Equal Pay for Equal Work Act we are disclosing the compensation range for roles that could be performed in the required city/states (California, Colorado, New York City and Washington State).