The Senior Risk Adjustment Analyst 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.

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

Required License(s) and/or Certification(s):

None

Skills/Knowledge/Competencies (Behaviors):

• Strong interpersonal and communication skills, both verbal & written
• Ability to effectively present analytic results using a variety of quantitative, qualitative, and visualization mediums
• Excellent analytical and problem-solving capabilities with special attention to accuracy and detail required
• Ability to manage multiple priorities and deadlines
• Proven ability to examine data from multiple sources and provide findings and recommendations to a wide range of audiences
• Proven strength in data management practices
• Advanced knowledge of Microsoft Office products, Tableau and/or equivalent data capture/reporting tools especially Transact-SQL
• Capable of determining when issues need escalation or prioritization with self-starter reliability and follow-through
• Ability to interact one on one and consult with all levels of executive management