Location/City : MA - Springfield
This position serves as a business analyst/technical project manager for the Risk Adjustment program. The Risk Adjustment projects require significant inter-departmental and intra-departmental collaboration as well as vendor management with a significant focus on data accuracy. The analyst will be responsible for managing projects or definable portions of projects, implementation related to systems/technical solutions, requirements gathering and documentation, and problem troubleshooting and resolution. This position is responsible for obtaining data from various internal sources, understanding relevant differences between each data source, and designing/creating database structures for analysis and reporting.
- Participate in systems testing, develop procedures/controls and provide recommendations for ongoing risk adjustment improvements
- Understand and monitor regulatory HCC requirements and technical specifications
- Interpret data and reports from CMS, such as MOR, MMR, RAPS Return file, Member Detail report, etc
- Provide leadership team with status of projects; issues, communicate and recommend policy decisions to achieve project objectives
- Develop and implement programs to maximize HCC risk scores
- Develop metrics to monitor results of each activity
- System/infrastructure requirements
- Responsible for the end-to-end management of data used in the creation, tracking and reporting of risk adjustment activities
- Develop data analytics to identify providers and members for appropriate HCC intervention
- Extracts data from multiple data sources and creates integrated analytic datasets and tools by defining meaningful metrics to address business questions.
- Represent department and division as requested on work groups and special assignments.
- Proposes strategies, develops, and implements them in risk adjustment reports
- Assist in oversight of external vendors providing HCC related services
- Develop and track metrics to measure vendor effectiveness
- Assess impact of program changes and communicate required changes to affected areas with the company
- Track business processes, consider options to overcome problems, and identify and escalate issues when appropriate
- Develop and maintain effective working relationships with customers or partners.
- Recommend chart review strategy/priorities and measure results.
|Bachelor’s degree in Business Administration, MIS, Computer Science or a related discipline and a minimum of three years experience in business analysis within the health care industry; or an equivalent combination of education and experience.|
- Intermediate to Advanced Microsoft Access experience required
- SQL experience preferred
- Familiarity with Medical Coding
- Excellent organizational and interpersonal skills
- Excellent written and verbal communication skills
- Excellent analytical skills
- Ability to be flexible in prioritizing workloads to meet changing deadlines
- Excellent time management and multi-tasking skills