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Senior Healthcare Economics Risk Adjustment Analyst

Company: P3 Health Group Management, LLC
Location: Henderson
Posted on: June 10, 2021

Job Description:

Senior Healthcare Economics, Risk Adjustment Analyst

 

People. Purpose. Passion.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.  

We are looking for a Senior HealthCare Economics Analyst Medicare Advantage Risk adjustment and Quality Programs.  If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing national organization based in Las Vegas, Nevada, then consider joining our team!  This role will be a leader in the comprehensive management of Medicare Risk Adjustment data, reporting and analysis.

Overall Purpose

This role will perform the following for Medicare Risk Adjustment programs:

  • Initiate and Perform advanced trend analytics to answer what happened?
  • Conduct root cause statistical analyses to answer why did this happen?
  • Develop predictive models to answer what will happen next? and who is it likely to happen to?
  • Mine data to answer where are the opportunities?
  • Develop methods/frameworks/models to answer what kind of decision problem is this?
  • Build models and deploy innovation processes and pilots to answer how can we get better?
  • Develop, support and manage reporting for internal management, health plan and provider partners to describe to various audiences Heres what happened, why it happened and where the opportunities are.

 

Responsibilities

  • Act as Lead and coach for other MRA analysts
  • Act as lead and coach for other MRA analysts
  • Recommend and guide process improvements that will ensure risk adjustment factor and disease burden data capture is complete and accurate.
  • Identify, analyze, interpret, and communicate risk adjustment trends to be consumed by management, provider partners and related entities.
  • Responsible for maintenance of existing reports, development of new reports to help ensure company goals are met, as well as other ad hoc requests as needed.
  • Identify and lead internal subject matter experts in regular meetings to identify and rectify various data submission and adjudication errors related to risk adjustment data submission.
  • Develop and maintain data sets leveraging internal data, response data from regulatory entities (MMR, MOR, RAPS Response, MAO-004, etc.), and ancillary data sources to be consumed across the enterprise.
  • Demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members.
  • Maintain strict oversight of vendor partners through analytic reconciliations to ensure regulatory compliance, optimal data submission and error resolution, and general accuracy.
  • Assist with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps.
  • Be a subject matter expert on current CMS regulations and announcements affecting risk adjustment. This includes review of regulatory announcements, attending educational sessions provided by regulatory entities, as well as staying apprised of educational opportunities within the industry.
  • Assist in developing, maintaining, and reporting out on actionable metrics related to risk adjustment and incorporating quality/health outcome metrics where applicable.
  • Work with changing data, file specifications, and internally coordinate releases and modifications through approved procedures.
  • Collaborate with internal and external partners to resolve data issues related to member, claim, provider and pharmacy data and processes.
  • Work with internal teams, provider partners, and vendor partners as needed to support risk adjustment activities.

Qualifications

  • Bachelors degree in Mathematics, Statistics or related field, or a Healthcare field.
  • 5+ years experience in data analytics related to health information required.
  • In depth Medicare risk adjustment Part C and Part D experience required, including risk models supporting CMS guidelines, RAPS/EDS data submissions, retrospective and prospective programs.
  • Familiarity with Risk Adjustment Documentation and Coding practices preferred.
  • Medicare Stars and/or HEDIS experience preferred.
  • Equivalent work and education experience will be considered.
  • Previous experience conducting program evaluation, outcomes research and exploratory data mining.
  • Experience with statistical software (e.g. SAS, R) and data management languages (e.g. Python, SQL)  is required.
  • Experience collaborating with others and establish working relationships, communicate effectively across the organization and at different levels, think and act strategically, and influence key leaders with a strong customer focus and management of stakeholder expectations.
  • Ability to successfully navigate and contribute in a matrixed environment to achieve the desired goals.
  • Driven professional that takes the initiative, ensures the goal is understood and executes timely and accurate analyses.

EQUAL OPPORTUNITY EMPLOYER

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

DIVERSITY & INCLUSION

At P3, we recognize and appreciate the importance of creating an environment in which all team members feel valued, included, and empowered to do their best work and bring great ideas to the table

Every P3 family member's unique experiences, perspectives, and viewpoints are valued and support our ability to deliver the best possible experience for our patients, providers, payers, partners, and each other.

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Keywords: P3 Health Group Management, LLC, Henderson , Senior Healthcare Economics Risk Adjustment Analyst, Other , Henderson, Nevada

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