Risk Adjustment Analyst II

Location: Columbus, OH
Position Purpose: 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.

Position Responsibilities:
  • 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 Centene’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. 

Tami Andrade Fitzpatrick
Senior Recruiter

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