This position is posted at a hierarchy and can be hired at either the Senior Healthcare Risk Adjustment Analyst level or Principal Healthcare Risk Adjustment Analyst level. The identified candidate will be hired at a level commensurate with their skills.
Senior Healthcare Risk Adjustment Analyst
This position supports Enterprise Risk Adjustment, a newly-created organization responsible for optimizing risk adjustment revenue through closing gaps in coding and care delivery across Blue Cross Medicare, Medicaid, and Exchange populations.Specifically, this position is responsible for business intelligence and analytics related to Enterprise Risk Adjustment.This position uses business intelligence, analytic, and data science techniques to improve risk adjustment results for these populations. This includes obtaining data from various internal sources, understanding relevant differences between each data source, designing and structuring files for analysis, and performing and interpreting descriptive, bivariate, and multivariate analyses.This position also will also be responsible for designing, conducting, and communicating analytics and research projects that support Enterprise Risk Adjustment.Content areas for this position will span:ERA Program Analytics: Answers the question of whether we are focused on the right members, the right types of gaps in coding and care, how much we have accomplished, what opportunities remain, and estimates the value of those opportunities in order to drive risk adjustment strategy and meet our revenue targets.Intervention and Pilot Test Analytics: Analytic and measurement support to inform pilot test/intervention design to ensure rigor in outcomes evaluation; evaluate pilot tests/interventions with respect to gap closure and ROI; and inform decisions about pilot/intervention modification and scale-up.Provider-Focused Analytics: Analytic and reporting support to understand provider performance on gaps in coding and care delivery and enable provider coaching.The Senior Healthcare Analyst analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping internal customers set strategic directions.The position should bring proven data analytics skills and a spirit of creativity and problem-solving to deepen insights into the factors that drive health care quality.The Senior Healthcare Analyst filling this position must be highly skilled from project design through implementation and have strong communication skills.The Senior Healthcare Analyst will work collaboratively in a team environment.
How Is This Role Important to Our Work?
This position will support Enterprise Risk Adjustment (ERA), a Stella Program responsible for optimizing risk adjustment revenue through closing gaps and risks in coding and care delivery across Blue Cross' Medicare, Medicaid, and ACA populations. Specifically, this position is responsible for business intelligence and analytics related to Enterprise Risk Adjustment. The applicant will achieve success using a combination of traits and skills including industry knowledge of risk assessment and risk adjustment knowledge domains, data and programming savvy, math and statistical abilities, and a spirit of creativity and problem-solving to deepen insights into the factors that drive health care quality and risk adjustment outcomes. A successful applicant will work independently as well as collaboratively with cross-functional teams to initiate, plan, and lead analysis from conceptual development to conclusion. The position will lead efforts with coworkers, internal business partners, and leadership to clarify requirements, analyze complex data, and produce and present meaningful and defensible results, including the identification of success factors and barriers, improvement opportunities, proposing solutions, and informing strategic decisions. The individual will also drive action based on the results obtained. The Risk Adjustment Data Analyst Pr will represent the department on both internal and external initiatives. They may also lead project teams. The incumbent will lead efforts to define meaningful contributions that will influence strategic decision-making and the optimization of Stars/Risk/Quality analytics at Blue Cross Blue Shield of Minnesota.