At PopHealthCare, our mission is simple - to lead the effort in reimagining how healthcare is delivered. We are bold innovators, dedicated to making a difference and we hire wicked smart people! 

Position Summary:
 

PopHealthCare has built an exceptional Revenue Analytics team to help forward-looking health plans succeed under new value-based care payment models. Risk adjustment is one of the most significant challenges facing these innovators. The Revenue Analytics team of experts in risk adjustment does it all - from data analytics & advanced modeling, to designing, presenting, and implementing industry-leading solutions. We are looking for a Senior Analyst to partner with this team to develop and maintain risk adjustment analytic capabilities. Success in this role comes from a combination of exceptional attention to detail and accuracy, top-notch data analysis and presentation skills, commitment to cross-functional teamwork, and an outstanding client service ethic. The incumbent will assist our organization as a subject-matter-expert in Medicare Advantage and/or Affordable Care Act (ACA) Risk Adjustment by leading business cases for algorithm development and improvement, researching customer queries of analytics performance, and creating requirements for new analytic products.
 

Position Essential Functions:
 

• Develop and implement best in class risk adjustment processes, including the facilitation and creation of relevant standard operation procedures (SOPs)
• Integrates best practices and tools to improve operational efficiency, reduce costs, and increase customer satisfaction.
• Communicates with systems development experts to design tools and applications to automate the fulfillment of repeat requests.
• Develops financial models to support various risk adjustment or performance initiative related decisions.
• Coordinate with internal teams to maintain, update and improve financial models.
• Organizes and provides executive and operational reporting and communication for PHC managed programs and products.
• Effectively develops and executes various financial analyses and data mining activities.
• Respond to customer requests involving ad hoc reporting or research
• Develop customer presentations and reporting enhancements to streamline operations and support processes.
• Guide clients and other teams on all facets of the Risk Adjustment process, from initial data capture at point-of-care, through acceptance to CMS, and successfully validated through audit.
• Research government regulatory guidance, provide expert interpretation for impacts to PopHealthCare products and customers
• Review and summarize CMS annual payment notice for Medicare Advantage, HHS (ACA), and Medicaid risk adjustment programs
• Ability to work independently as well as contribute to knowledge-sharing within a team environment.
• Demonstrates excellent analytical and problem-solving skills.
• Use strong data analysis skills (e.g., SAS/SQL/Excel) to produce timely and accurate reports and insights.

• Minimum Bachelors degree in Actuarial Science, Math, Statistics, or in a related field of study
• 3+ years experience producing risk adjustment analysis related to the Medicare Advantage, Medicaid, and/or ACA program.
• Experience supporting the development of scalable analytic and reporting solutions
• 3+ years experience in healthcare industry, with a focus on Risk Adjustment
• Experience with MA/ACA Risk Scoring methodology, including familiarity with condition categories (HCC)
• Experience interacting with large amounts of healthcare data
• Experience working with clinical classification such as diagnoses (ICD), procedures (HCPCS, CPT) and claims processing
• End-to-end experience working with risk adjustment submission systems (RAPS, EDPS, EDGE), including background on filtering logic for each system
• Experience with forecasting risk adjustment payments including MA mid-year and final year projections and/or ACA transfer payments
• Knowledge of regulations related to Medicare Advantage, Medicaid, and/or Commercial risk adjustment.
• Moderate to advanced SQL skills. SAS experience preferred but not required.
• Demonstrated commitment to delivering outstanding products and service that meet or exceed our clients expectations.
• Ability to interact effectively with both technical and non-technical staff across the organization including clinicians and management.
• Ability to initiate and maintain cross-team relationships.
• Excellent verbal and written communication skills.
• Ability to provide narrative context of data analysis to a non-technical audience.

All your information will be kept confidential according to EEO guidelines.