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Risk Adjustment Revenue Analytics Job
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| Employer Name: |
SpiderID: 13928919 |
| Location: El Segundo, California |
Date Posted: 1/19/2025 |
| Wage: Negotiable |
Category: Insurance |
| Job Code: 17001EO-2191 |
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Job Description:
 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
We seek to add a Risk Adjustment Analyst to the Medicare Risk Adjustment team.
The Risk Adjustment- Individual Contributor role provides significant support in the Medicare Risk adjustment area as it pertains to submissions of information to CMS and working closely with our provider/vendor partners. Primary duties will include working closely with other Risk Adjustment team members and cross functionally within the Blue Shield (BSC)/Care1st organizations resolving issues to ensure accurate diagnostic information in regards to our members.
Works closely with leaders and other team members on submissions, retrospective and prospective programs, and analytics while ensuring key timelines are met.
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Regular reporting of organization (BSC/Care1st)/CA performance on key metrics to all management levels
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Works closely with Care1st team, providing support/oversight as needed.
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Works cross-functionally with internal departments such as IT, ACO, provider relations, and provider contracting teams to support risk adjustment efforts.
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Manages and works cross-functionally across different functional areas like claims, enrollment, provider, etc.
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Able to track expenditures, develop forecasts, and ensures appropriate controls are in place to mitigate unnecessary costs.
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Work closely with other areas in the risk adjustment team (e.g. financial forecasting and reconciliations, data quality, and data validation)
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Researches risk adjustment opportunities by utilizing and reviewing tools provided by analytics team and / or a third-party vendor
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Frequently utilize intermediate to advanced level of skills in SAS and MS-Excel.
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Maintains current knowledge of CMS-HCC and risk adjustment policies, procedures and best practices; develops and presents departmental materials
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Special projects as requested
Qualifications:
Knowledge:
This role requires extensive healthcare knowledge, particularly in relation to Medicare risk adjustments, with a strong knowledge of CMS regulations.
The role require strong analytic skills and the ability to quickly understand and summarize reports, and their implications.
The role requires strong interpersonal as well as written and oral communication skills for both external and cross-functionally within BSC/Care1st.
Required Skills
10+ years of applied analytic skills in health care including deep, expert knowledge of Medicare Advantage.
Strong oral and written communication skills including demonstrated success communicating at the VP level and above with both internal and external executive partners
Extensive knowledge of health insurance operations including installation, claims payment and customer service.
Demonstrated ability to portray confidence as a subject matter expert and negotiator.
Demonstrated ability to be productive and get things done in a rapidly changing start-up environment where new analytical models, processes, tools and business models needs to be rapidly developed, tested and deployed
Given the absolute criticality of BSC's membership growth strategy to helping the company achieve its new "affordability" mission, this resource must be extremely seasoned. Deep analytical skills, broad health insurance operations & business knowledge and strong skills in executive presenting and vendor management are critical success factors.
Desired:
Actuarial background is a plus, but equivalent work experience is substitutable
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: Blue Shield of California |
Company Type: |
| Company: Blue Shield of California |
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