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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