Senior Health Care Analyst-Risk Adjustment - 12909_5-4459

Emergent Holdings • Chicago, IL • 1d ago

This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/12949638 SUMMARY:

The Senior Health Care Analyst is responsible for planning, organizing, directing, implementing, and leading department assignments related to Medicare Risk Adjustment. This role involves analyzing clinical, claims, and enrollment data to ensure compliance with government regulations, identifying trends, and collaborating with cross-functional teams to improve risk adjustment strategies and processes. This position operates within broad objectives to ensure optimum utilization of manpower and budget.

RESPONSIBILITIES/TASKS:

Provide analytical support on prospective and retrospective

initiatives, trends and identify areas for improvement.

Uses a combination of data/text mining, analysis, reporting,

predictive and risk modeling to support leadership and business decisions.

Builds and supports business reports to be included in executive

dashboard.

Leads in the research, analysis, identification, and evaluation of

data from assigned problems to evaluate existing and potential trends and issues.

Possesses and maintains an extensive comprehensive knowledge of

BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles and methodologies.Manages and monitors multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.

Develops lines of communication to discuss and review results of

analysis to management via reports and presentations and assists management in implementing programs that provide solutions.

Investigates, reviews, recommends, communicates, and implements

solutions which identify problems/root cause of issues.

Identifies and resolves challenges in order to fulfill key corporate

objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.

Independently develops and plans reports, papers, and/or other

materials in a clear and concise manner.

Provides expertise and guidance to unit and corporate staff as

required.

Acts as a liaison between corporate business areas and participates

in group or committee discussions.

Supports ongoing maintenance of executive dashboard and related

products, applications, and platforms, continuously striving towards automation.

Works with analytics business analysts/developers and operations

personnel to automate dashboard functions.

Completes ad hoc data and analytic requests as assigned.

Competent in SAS (Base, Macro, Graph, Email); Visio; Visual Basic

for automation in Excel, Visio, Access, PowerPoint; SQL (Oracle, SQL/Server); ETL into Oracle; system tools (Windows/Linux command line coding, scheduling programs in both); creation of file structures (flat, delimited, etc.).

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor\'s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, Mathematics, or a related field. Master\'s degree in a related field is preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company\'s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Seven years experience in a related field, typically in two subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

Knowledge of CMS Medicare HCC risk adjustment models and

methodologies, ICD-10 coding, and interacting with large amounts of healthcare data.

Working knowledge of data languages such as SAS, SQL, Python, or R.

Excellent analytical, planning, problem solving, verbal, and written

skills to communicate complex ideas.

Excellent knowledge and use of existing software packages

(PowerPoint, Excel, Word, etc.) and data visualization skills (PowerBI, Tableau, etc.).

CMS reporting, Medicare data reporting, claims data reporting, and

enrollment data reporting preferred.

Ability to work independently, within a team environment, and

communicate effectively with employees at all levels.

WORKING CONDITIONS:

WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate\'s skills and professional experience,

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