TechMind RPO
Healthcare Risk Adjustment Analytics (Denver)
TechMind RPO, Denver, Colorado, United States, 80285
Job Overview:
A leading kidney care organization is seeking a
Senior Manager, Risk Adjustment Analytics
to lead the strategy and execution of risk adjustment analytics within its Integrated Care division. This role plays a crucial part in shaping financial performance through advanced analytics, compliance oversight, and collaboration with cross-functional teams. If you're passionate about data-driven strategy, healthcare economics, and leading teams, this role offers a dynamic opportunity to drive impact at scale.
Key Responsibilities: Oversee and enhance the accuracy of risk adjustment financial models and processes. Develop executive-level reporting to monitor revenue metrics and evaluate initiative impacts on Medical Loss Ratio (MLR). Utilize SQL to query large datasets from clinical and claims data systems to generate actionable insights. Stay informed and compliant with CMS risk adjustment rules, policies, and submission systems. Collaborate with finance, operations, clinical, compliance, legal, and IT stakeholders to optimize performance. Act as a subject matter expert on CMS risk adjustment trends and best practices. Lead and mentor analytics professionals to drive performance.
Required Experience: 3+ years working with healthcare data, specifically claims or encounter data using SQL. 3+ years of experience in healthcare finance, medical economics, or consulting in population health. 1+ year in designing and assessing risk adjustment initiatives (prospective and retrospective) including CMS RAPS/Encounter submissions. Prior experience in managing and developing direct reports.
Required Skills: Deep understanding of CMS-HCC models (V24, V28), claims lifecycle, and compliance regulations. Strong knowledge of healthcare finance, value-based care, and population health metrics. Excellent presentation and storytelling skills, with the ability to convey complex data to senior leadership. High adaptability in dynamic environments, with a self-driven, entrepreneurial approach. Project management expertise and strategic thinking.
Senior Manager, Risk Adjustment Analytics
to lead the strategy and execution of risk adjustment analytics within its Integrated Care division. This role plays a crucial part in shaping financial performance through advanced analytics, compliance oversight, and collaboration with cross-functional teams. If you're passionate about data-driven strategy, healthcare economics, and leading teams, this role offers a dynamic opportunity to drive impact at scale.
Key Responsibilities: Oversee and enhance the accuracy of risk adjustment financial models and processes. Develop executive-level reporting to monitor revenue metrics and evaluate initiative impacts on Medical Loss Ratio (MLR). Utilize SQL to query large datasets from clinical and claims data systems to generate actionable insights. Stay informed and compliant with CMS risk adjustment rules, policies, and submission systems. Collaborate with finance, operations, clinical, compliance, legal, and IT stakeholders to optimize performance. Act as a subject matter expert on CMS risk adjustment trends and best practices. Lead and mentor analytics professionals to drive performance.
Required Experience: 3+ years working with healthcare data, specifically claims or encounter data using SQL. 3+ years of experience in healthcare finance, medical economics, or consulting in population health. 1+ year in designing and assessing risk adjustment initiatives (prospective and retrospective) including CMS RAPS/Encounter submissions. Prior experience in managing and developing direct reports.
Required Skills: Deep understanding of CMS-HCC models (V24, V28), claims lifecycle, and compliance regulations. Strong knowledge of healthcare finance, value-based care, and population health metrics. Excellent presentation and storytelling skills, with the ability to convey complex data to senior leadership. High adaptability in dynamic environments, with a self-driven, entrepreneurial approach. Project management expertise and strategic thinking.