Sr Manager, Risk Adjustment Analytics
On-siteDenver, Colorado, United States
Job Summary
Lead strategic management for Integrated Kidney Care Risk Adjustment Accuracy, creating leadership reports on revenue financials and estimating initiative impacts on Medical Loss Ratio. Write SQL queries against clinical and claims data warehouses to support analytic requests and deliver insights to stakeholders. Monitor evolving CMS regulations and policies to ensure compliance across all processes and reporting. Partner with clinical, financial, operational, legal, compliance, and IT teams to improve risk adjustment accuracy while serving as the enterprise subject matter expert on CMS risk adjustment. Present complex analysis to executive audiences and manage direct reports to drive independent improvement initiatives.
Required Qualifications
- 3 or more years professional experience with healthcare data, specifically medical claims and/or encounter data using SQL
- 3 or more years experience in healthcare financial management, healthcare consulting, medical economics, population health, and/or similar experience
- At least a years experience in creation, implementation, and impact estimation of prospective and retrospective risk adjustment initiatives, including CMS RAPS/Encounter data submissions
- Experience developing and managing direct reports
- Expert level knowledge of CMS-HCC models V24 and V28, claims data lifecycle, submission systems, regulation, compliance, and audits related to risk adjustment
- Strong understanding of healthcare economics, population health, and value based care
Desired Qualifications
- Intellectual curiosity, strategic thinking and strong project management skills
- Comfort with ambiguous, ever-changing situations
- Strong entrepreneurial mindset with the motivation to continuously improve the status quo and drive this independently
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