Risk Adjustment Analyst

Position Summary:
This role will provide analytical support to the Risk Adjustment Operations team. We're seeking a detail-oriented, curious, and collaborative individual interested in fostering operational success through data driven insights. This role will provide in-depth data analysis and interpretation, manage data requirements to support operations, maintain reporting to monitor performance, and identify efficiencies to optimize program outcomes. This individual must communicate with confidence, build relationships through inspiring trust and sharing information, and be able to challenge assumptions constructively. This role requires frequent interaction / cross-collaboration with both Medicare and Commercial Operations, Health & Medical Management, IT, vendor partners, and others.

Key Responsibilities/Accountabilities:

• Collect, analyze, and synthesize data; develop analyses and reporting to guide the Medicare strategy.

• Assist in creation and maintenance of reports that monitor key program performance on a regular basis.

• Become an expert in our medical record retrieval workflow to proactively support chart retrieval, coding, and QC data needs throughout program cycles.

• Manage data requirements for different Risk Adjustment activities such as in-home health assessments, annual CMS and HHS audits, risk mitigation, etc.

• Support requests for ad hoc analysis leveraging disparate data sources including Medicare reporting and the Data Warehouse.

• Assist in vendor management with, including but not limited to, data transfer and reconciliation, performance reporting, and risk mitigation.

• Critically review results of analytics to make recommendations on process improvements and changes to strategic approaches.

• Clearly and concisely present analytic information to internal and external audiences, both verbally and in written format.

• Work closely with the Manager and broader analytics team to collaborate on analyses and resolve complex problems.

• Foster a team-based environment through participation in projects and activities that support the goals of the team.

• Perform other related projects and duties as assigned

Qualifications:

• Understanding of standard healthcare data and the healthcare industry preferred

• Familiarity with Medicare claims is a plus

• Demonstrated analytical and decision-making skills

• Must be proficient with MS Access, Excel, and SQL

• Experience with Tableau and SAS is a plus

• Demonstrated ability to handle multiple tasks simultaneously

• Experience participating in cross-functional teams

• Excellent oral and written communications skills evidenced by the ability to present information effectively

• High degree of initiative and professionalism; ability to effectively interact with all levels of an organization and leadership

• Willingness to develop new technical skills

• The ability to work independently on multiple projects and in a collaborative team environment

Education/Relevant Experience:

• Bachelor's degree or equivalent work experience required

• 2+ years analytic experience in a support role preferred

• 2-3 years of business experience in health insurance

• Medicare Advantage experience a plus

• Overall Medicare experience preferred

This position is eligible for the following personas: eWorker, Mobile, Resident.

#LI-REMOTE

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.