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Sr. Risk Adjustment Data Analyst

Company: Sentara
Location: Glen Allen
Posted on: January 27, 2023

Job Description:

City/StateGlen Allen, VAOverviewWork ShiftFirst (Days) (United States of America)Sentara Health Plan is seeking an experienced professional to join our team as Sr. Risk Adjustment Data Analyst * This position is 100% remote but candidates must have a current residence in one of the follow states or being willing to relocate: FL, GA, IN, MD, NV, SC, NC, SD, TN, TX, VA, WV, WIMinimum Requirements:Required Education :Bachelor's Degree in Mathematics, Statistics, Finance, Economics, Computer Science, or related Required Experience :3 - 5 years in data analysis, predictive modeling, Medical Economics or related

  • Advanced Knowledge of SQL and knowledge of Tableau is required
  • Familiarity with external data sources including Medicare, Medicaid, and Health Exchange data files is required.
  • Requires a high level of understanding of Centers for Medicare and Medicaid (CMS), Health and Human Services (HHS), or Virginia Department of Medical Assistance (VA-DMAS) Risk Adjustment programs.
  • Excellent Oral and Written Communication Skills -Ability to break out complex technical processes and explain to non-technical audiences.
  • Consultative Engagement Skills .
  • Ability to break out complex technical processes and explain to non-technical audiences Job Summary & Responsibilities:The Senior Risk Adjustment Data Analyst provides data analysis supports to Sentara Health Plans' Revenue Management team, affiliated internal departments, and external vendor partners. The Senor RA Analyst supports in designing and implementing processes and solutions utilizing a wide variety of data sets to resolve business challenges in relation to optimizing Risk Adjustment premium revenue. The senior analyst uses a combinations of data/text mining, analysis, reporting, predictive and risk modeling to support informed business decisions. This requires complete understanding of claims, pharmacy, lab, network utilization, and cost containment data. Additionally, familiarity with external data sources including Medicare, Medicaid, and Health Exchange data files is required.The Senior RA Data Analyst is required to show independent thinking. The senior analyst assists in identifying business challenges, support development of processes to address the challenges, and metrics to track and monitor business processes. This requires a high level of understanding of Centers for Medicare and Medicaid (CMS), Health and Human Services (HHS), or Virginia Department of Medical Assistance (VA-DMAS) Risk Adjustment programs. The Senior RA Data Analyst must develop Subject Matter Expertise in CMS, HHS, and VA-DMAS Risk Adjustment programs. The subject matter expertise required will vary based on the specific program the Senior Analyst supports but a general understanding of Risk Adjustment programs is expected, including:
    • Understanding of Prospective and Retrospective Risk Adjustment Interventions
    • Mastery of at least one of CMS, HHS, DMAS Risk Adjustment models
    • General understanding of the other two Risk Adjustment models
    • Mastery of risk classification and diagnosis grouping to disease categories
    • Lead in development of Performance reports in support of provider engagement
    • Implement logic to identify members for Risk Adjustment interventions
    • Lead in implementation of vendor extracts to support Risk Adjustment interventions
    • Understanding of Database principles and development of relational tables and views
    • Works with internal, external and enterprise individuals as needed to research, develop, and document new standard reports or processes
    • Advanced Knowledge of SQL and knowledge of Tableau
    • Excellent Oral and Written Communication Skills
    • Problem Solving
    • Consultative Engagement Skills
    • Ability to break out complex technical processes and explain to non-technical audiences Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health.As the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:
      • Medical, Dental, and Vision Insurance
      • Paid Annual Leave, Sick Leave
      • Flexible Spending Accounts
      • Retirement funds with matching contribution
      • Supplemental insurance policies, including legal, Life Insurance and AD&D among others
      • Work Perks program including discounted movie and theme park tickets among other great deals
      • Opportunities for further advancement within our organizationSentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within avibrant, creative, and highly productive workplace. For information about our employee benefits, please visit:Benefits - Sentara (sentaracareers.com)Join our team!We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth! Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-beingin mind. Ourbenefits packages are designed to change with you by meeting yourneeds now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.Job SummaryThe Senior Risk Adjustment Data Analyst provides data analysis supports to Sentara Health Plans' Revenue Management team, affiliated internal departments, and external vendor partners. The Senor RA Analyst supports in designing and implementing processes and solutions utilizing a wide variety of data sets to resolve business challenges in relation to optimizing Risk Adjustment premium revenue. The senior analyst uses a combinations of data/text mining, analysis, reporting, predictive and risk modeling to support informed business decisions. This requires complete understanding of claims, pharmacy, lab, network utilization, and cost containment data. Additionally, familiarity with external data sources including Medicare, Medicaid, and Health Exchange data files is required.

        The Senior RA Data Analyst is required to show independent thinking. The senior analyst assists in identifying business challenges, support development of processes to address the challenges, and metrics to track and monitor business processes. This requires a high level of understanding of Centers for Medicare and Medicaid (CMS), Health and Human Services (HHS), or Virginia Department of Medical Assistance (VA-DMAS) Risk Adjustment programs. The Senior RA Data Analyst must develop Subject Matter Expertise in CMS, HHS, and VA-DMAS Risk Adjustment programs. The subject matter expertise required will vary based on the specific program the Senior Analyst supports but a general understanding of Risk Adjustment programs is expected, including:



        Understanding of Prospective and Retrospective Risk Adjustment Interventions

        Mastery of at least one of CMS, HHS, DMAS Risk Adjustment models

        General understanding of the other two Risk Adjustment models

        Mastery of risk classification and diagnosis grouping to disease categories

        Lead in development of Performance reports in support of provider engagement

        Implement logic to identify members for Risk Adjustment interventions

        Lead in implementation of vendor extracts to support Risk Adjustment interventions

        Understanding of Database principles and development of relational tables and views

        Works with internal, external and enterprise individuals as needed to research, develop, and document new standard reports or processes


        Advanced Knowledge of SQL and knowledge of Tableau

        Excellent Oral and Written Communication Skills

        Problem Solving

        Consultative Engagement Skills

        Ability to break out complex technical processes and explain to non-technical audiences


        Required Education

        Bachelor's Degree in Mathematics, Statistics, Finance, Economics, Computer Science, or related


        Required Experience

        3 - 5 years in data analysis, predictive modeling, Medical Economics or relatedQualifications:BLD - Bachelor's Level Degree (Required)Data AnalysisSkillsSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
        In support of our mission "to improve health every day," this is a tobacco-free environment.

Keywords: Sentara, Richmond , Sr. Risk Adjustment Data Analyst, Professions , Glen Allen, Virginia

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