Staffingine LLC
Sr. Manager, Risk Adjustment Analytics
Staffingine LLC, Denver, Colorado, United States, 80285
Overview
Job Title :
Sr Manager Risk Adjustment Analytics Job Location :
Denver CO Job Type :
Full Time Employment Type :
Full Time Experience :
years Vacancy :
1 Job Description
Provide strategic leadership and management for the IKC Risk Adjustment Accuracy Create and maintain leadership reports on IKC revenue financials and estimating impact IKC initiatives had on Medical Loss Ratio (MLR) Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to various stakeholders Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements Partner with clinical financial operational legal compliance and IT teams to improve risk adjustment accuracy Serve as a subject matter expert on CMS risk adjustment for the enterprise and stay current on the latest industry trends Other duties as assigned Responsibilities
Provide strategic leadership and management for the IKC Risk Adjustment Accuracy Create and maintain leadership reports on IKC revenue financials and estimating impact IKC initiatives had on Medical Loss Ratio (MLR) Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to various stakeholders Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements Partner with clinical financial operational legal compliance and IT teams to improve risk adjustment accuracy Serve as a subject matter expert on CMS risk adjustment for the enterprise and stay current on the latest industry trends Other duties as assigned Qualifications
Required Experience : 3 or more years professional experience with healthcare data specifically medical claims and / or encounter data using SQL 3 or more years experience in healthcare financial management healthcare consulting medical economics population health and / or similar experience At least a years experience in creation implementation and impact estimation of prospective and retrospective risk adjustment initiatives including CMS RAPS / Encounter data submissions Experience developing and managing direct reports Skills and knowledge
Skills and knowledge needed to succeed in this role : Expert level knowledge of CMS-HCC models V24 and V28 claims data lifecycle submission systems regulation compliance and audits related to risk adjustment Strong understanding of healthcare economics population health and value based care Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization Comfortable presenting complex analysis and insights to executive audience Intellectual curiosity strategic thinking and strong project management skills Comfort with ambiguous ever-changing situations Strong entrepreneurial mindset with the motivation to continuously improve the status quo and drive this independently Must-haves
Experience developing and managing direct reports Expert level knowledge of CMS-HCC models V24 and V28 claims data lifecycle submission systems regulation compliance and audits related to risk adjustment Strong understanding of healthcare economics population health and value based care Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization Comfortable presenting complex analysis and insights to executive audience Intellectual curiosity strategic thinking and strong project management skills Comfort with ambiguous ever-changing situations Strong entrepreneurial mindset with the motivation to continuously improve the status quo and drive this independently Key Skills
Key Skills Adobe Analytics Data Analytics SQL Attribution Modeling Power BI R Regression Analysis Data Visualization Tableau Data Mining SAS Analytics
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Job Title :
Sr Manager Risk Adjustment Analytics Job Location :
Denver CO Job Type :
Full Time Employment Type :
Full Time Experience :
years Vacancy :
1 Job Description
Provide strategic leadership and management for the IKC Risk Adjustment Accuracy Create and maintain leadership reports on IKC revenue financials and estimating impact IKC initiatives had on Medical Loss Ratio (MLR) Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to various stakeholders Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements Partner with clinical financial operational legal compliance and IT teams to improve risk adjustment accuracy Serve as a subject matter expert on CMS risk adjustment for the enterprise and stay current on the latest industry trends Other duties as assigned Responsibilities
Provide strategic leadership and management for the IKC Risk Adjustment Accuracy Create and maintain leadership reports on IKC revenue financials and estimating impact IKC initiatives had on Medical Loss Ratio (MLR) Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to various stakeholders Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements Partner with clinical financial operational legal compliance and IT teams to improve risk adjustment accuracy Serve as a subject matter expert on CMS risk adjustment for the enterprise and stay current on the latest industry trends Other duties as assigned Qualifications
Required Experience : 3 or more years professional experience with healthcare data specifically medical claims and / or encounter data using SQL 3 or more years experience in healthcare financial management healthcare consulting medical economics population health and / or similar experience At least a years experience in creation implementation and impact estimation of prospective and retrospective risk adjustment initiatives including CMS RAPS / Encounter data submissions Experience developing and managing direct reports Skills and knowledge
Skills and knowledge needed to succeed in this role : Expert level knowledge of CMS-HCC models V24 and V28 claims data lifecycle submission systems regulation compliance and audits related to risk adjustment Strong understanding of healthcare economics population health and value based care Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization Comfortable presenting complex analysis and insights to executive audience Intellectual curiosity strategic thinking and strong project management skills Comfort with ambiguous ever-changing situations Strong entrepreneurial mindset with the motivation to continuously improve the status quo and drive this independently Must-haves
Experience developing and managing direct reports Expert level knowledge of CMS-HCC models V24 and V28 claims data lifecycle submission systems regulation compliance and audits related to risk adjustment Strong understanding of healthcare economics population health and value based care Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization Comfortable presenting complex analysis and insights to executive audience Intellectual curiosity strategic thinking and strong project management skills Comfort with ambiguous ever-changing situations Strong entrepreneurial mindset with the motivation to continuously improve the status quo and drive this independently Key Skills
Key Skills Adobe Analytics Data Analytics SQL Attribution Modeling Power BI R Regression Analysis Data Visualization Tableau Data Mining SAS Analytics
#J-18808-Ljbffr