Sr. Manager, Risk Adjustment Analytics

Job Title : Sr Manager, Risk Adjustment Analytics

Job Location : Denver, CO

Job Type : Full Time

Job Description :

Provide strategic leadership and management for the IKC Risk Adjustment Accuracy

Create and maintain leadership reports on IKC revenue financials and estimating impact IKC initiatives had on Medical Loss Ratio (MLR)

Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to various stakeholders

Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements

Partner with clinical, financial, operational, legal, compliance, and IT teams to improve risk adjustment accuracy

Serve as a subject matter expert on CMS risk adjustment for the enterprise and stay current on the latest industry trends

Other duties as assigned

Required Experience :

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 year's 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

Skills and knowledge needed to succeed in this role :

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

Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization

Comfortable presenting complex analysis and insights to executive audience

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

Must-haves

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 Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization Comfortable presenting complex analysis and insights to executive audience 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