Risk Adjustment Analyst
Columbus, OH 43085
- Responsible for advanced and predictive data analytics using big data and data science technology for healthcare innovation and outcomes.
- Perform analysis using data science techniques on structured and unstructured data sets, and develop algorithms for Risk Adjustment.
- Design, develop and maintain risk adjustment data models.
- Prepare risk score projections to estimate future payments.
- Researches and reports on relevant regulatory and process changes impacting risk adjustment and financial performance.
- Tracks and monitors encounter data submissions and supplemental information to state and federal systems.
- Manage relationship and oversight of various risk adjustment vendors.
- Design and construct analysis tools that extract, and analyze data and store analytical results in an appropriate format for business needs.
- Conduct exploratory data analysis from complex data sources and build key data sets to support company's mission.
- Evaluate and design experiments to monitor key metrics and identify improvement opportunities.
- Develop mathematical and statistical models to distinguish relevant content or events and recognize patterns.
- Participate in presentations and communicate results of analysis and findings.
- Participate in the design of automated, operational analytics processes to achieve scale and durability of analysis processes.
- Validate and measure the outcomes of health management programs using SAS, R and other tools, to include provider data, claims data, membership data.
- Manage multiple projects as assigned.
- Assist with training Data Analysts.
- Master's degree in Statistics, Mathematics, Computer Science, Informatics, Econometrics, Engineering, Experimental Science with 3+ years of experience or Bachelor s degree and 5+ years of quantitative analysis experience in data science capabilities including data mining, predictive modeling, machine learning, statistical modeling, large scale data acquisition, transformation, and structured and unstructured data analysis.
- Experience with database technologies, including Oracle, SAP, DB2, Teradata, MS SQL Server, SAP HANA, MySQL.
- Healthcare & Risk Adjustment experience strongly preferred.
- SAS and Micro Strategy experience preferred.
For more information on this position, please call 877-782-3334.