Senior Risk Adjustment Analyst - Health Plan (Remote)

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

NEW POSITION This position offers a remote work schedule and 2-4 visits to Maine, per year! Join this dynamic Risk Adjustment Team in our Health Plan which is growing and making an impact! Apply today for immediate consideration!

The Senior Risk Adjustment Analyst in our Health Plan analyzes data, reviews findings, and develops recommendations for leadership related to revenue optimization utilizing third party software as well as the data warehouse as key sources of data. The Senior Analyst uses their extensive content knowledge and analytical expertise to guide and educate leaders on revenue optimization from a range of operational lenses and levels of analysis. This individual may lead project teams and process improvement activities in their area of expertise.

Job Description

Key Outcomes:

• Examines and performs data management analyses and develops and presents a variety of performance results in addition to other pertinent communication

• Transfers data into meaningful, professional, and easy to understand formats for leadership

• Reviews data, develops recommendations and reviews findings with senior leadership

• Analyzes and extracts data from the Enterprise Data Warehouse (EDW) and other sources to report to internal and external customers

• Designs, develops, tests, documents, and maintains database queries for ad hoc reporting used in complex conceptual analyses for all departments within Risk Adjustment Operations

• Develops systematic reporting processes and procedures to ensure timely delivery of daily, weekly, monthly, annual, and ad hoc reports to support key departmental and organizational initiatives

• Serves as the liaison between departments including IT and Finance for all Risk Adjustment reporting needs

• Troubleshoots errors and data inconsistencies and coordinates resolutions to issues as directed by self, staff, and various levels of leadership

• Takes a lead role in the tracking of progress and activities of key initiatives

• Plans and assists with testing processes and activities including new report or analytics methodology validation

• Responsible for documenting and updating changes to workflow, training plans, policies and procedures and ensure redundancy in these knowledge areas with other analytics resources

• Provides analytic mentorship and guidance to operational departments related to revenue optimization

• Participates in the development of risk adjustment operational and strategic planning processes

• Subject matter expert in CMS HCC Risk Adjustment modeling

• May lead vendor research, software installation, configuration support, and interface development applications as needed

• Maintains and is expert user of third-party analytical tools and reporting platforms related to risk profile analysis and HCC coding

• Recommends tools and methodologies that can be deployed at the organizational level, to the departments and with external partners

Education/Experience:

• Bachelor's degree in Economics, Finance, Statistics, Mathematics, Actuarial Sciences, or other quantitative discipline; Master's degree preferred

• Minimum of 5 years' experience related to reporting and analysis of health care data ideally in the areas of managed care, health care delivery, code sets, and/or reimbursement

• Experience in developing cost-benefit and ROI analyses

• In compliance with MPHC's Department of Defense government contract, any/all persons hired for this position will need to verify their US citizenship and complete the required employment eligibility verification upon hire.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org