Manager, Risk Adjustment Analytics

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Evergreen Nephrology

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💰 $4.3M Venture Round on 2022-06

Description

• Responsible for the deployment of comprehensive, compliant risk adjustment analytics • Provide operational insights on the completeness and accuracy of coding for all members • Support financial forecasting with Risk Adjustment Factor projections • Develop automated processes to calculate CMS RAF in SQL or Python • Serve as Evergreen’s internal expert pertaining to CMS RAF model • Maintain and update RAF calculation process for CMS changes and updates • Develop process to filter claims for risk adjustability • Oversee the development of key analytics and data for Risk Adjustment • Analyze RAF build over time and forecast year-end RAF • Establish and maintain technical and procedural infrastructure for Risk Adjustment • Develop analytics to track performance of leading indicators and KPIs • Create and maintain dashboards for internal and external reporting • Collaborate with operations teams for necessary analytics • Work closely with legal and compliance teams to create QA strategy • Collaborate with data and tech teams for RAF analytics outputs • Regular and reliable attendance

Requirements

• Bachelor’s Degree in Finance, Math, Economics, or related field • Three (3) years of experience in healthcare financial management, healthcare consulting, and/or population health experience • Three (3) years of experience in risk adjustment in a Medicare Advantage environment with detailed knowledge of the CMS RAF model • Three (3) years experience with healthcare data, specifically medical claims and/or encounter data • Three (3) years experience with SQL and/or Python • Deep understanding of compliance within risk adjustment and how it supports the organization’s viability • Experience building a robust performance monitoring and quality assurance structure • Excellent communication skills both written and verbal • Intermediate skills with MS Office Suite of products including Outlook and Teams • Minimum download speed of 25 Mbps and an upload speed of 10 Mbps required

Benefits

• Competitive base pay with bonuses • Paid time off starting at four weeks for full-time employees • 12 paid holidays per year • Reimbursement for continuing medical education • 401k with match • Health, dental, and vision insurance • Family-friendly policies that support paid parental leave and flexible work arrangements • Robust training and development program that starts with onboarding