Manager, Risk Adjustment Analysis

Location: El Segundo, CA
ESSENTIAL FUNCTIONS
  • Responsible for HR responsibilities of 1 or more analysts.
  • Primary responsibility is to perform Medicare  Risk Adjustment  Analysis and reporting :
  • Manage/Perform analysis and reporting activities relating to:  risk score calculation, claims/encounters data submission, chart review programs and audits, and related performance metrics.
  • Design and develop dashboard for reporting related to Risk Adjustment Financial metrics.
  • Analysis and reporting on HCC program initiatives relative to benchmarks/targets.
  • Analysis and reporting on CMS data like MMR and MOR received through various health plans.
  • Develop tools and conduct analysis to evaluate accuracy and completeness of encounter exchange with capitated providers.
  • QA data submissions to health Plans.
  • Work with EDI team to ensure timely and accurate encounter submissions to health plans and other state or federal agencies. Analyze the financial impact of data issues and encounter rejection buckets.
  • Communicate and collaborate with internal and external stakeholders on risk adjustment related analysis, knowledge or both.
  • Comply with HIPAA Regulations and company compliance policy.
  • Stay updated and share knowledge on industry changes especially any changes on CMS side (changes like ICD10, EDS, Payment Model Changes)
 
EDUCATION
  • Bachelor’s degree from a four-year college; preferred: major in information systems or related quantitative field (finance, computer science or, mathematics).
  • And/or a professional certification requiring formal education beyond a two-year college
 
QUALIFICATIONS
  • 5 - 7 years of healthcare analytics experience.
  • Strong understanding of Medicare Risk Adjustment Payment Model and Cycle including the knowledge base to calculate and manipulate risk scores.
  • Experience with Risk Score and Revenue forecast is a plus.
  • Deep familiarity with CMS data and risk adjustment processes including MMR, MOR and EDS data.
  • Strong understanding of Claims and Encounter data.
  • Strong command on SQL Server (T-SQL), SSIS and SSRS, and Database design.
  • Strong analytical/financial skills
  • Proficient with MS Office, MS-Access, MS-Visio.
 
KNOWLEDGE, SKILLS, ABILITIES:
  • Commitment to DaVita’s core values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun. Ability to demonstrate the core values positively and proactively to patients, teammates, management, physicians, and/or vendors (Village Service Partners) in everyday performance and interactions.
  • Comfortable in and excited to be a part of an ever-evolving environment and team.
  • Exceptional project management; ability to organize, direct and lead special projects.
  • Proven ability to "get stuff done" and liaise with cross-functional constituents.
  • Ability to communicate appropriately and efficiently with top senior executives both internally and externally
  • Ability to prioritize major projects and/or programs that require strict and time sensitive deadlines.
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 

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