Job Description

Job Title: Risk Adjustment and Medicare Performance Analyst
Contract: 6 Months

Location: Remote
Pay rate: $30-$35

Job Description:

The Risk Adjustment and STARS Analyst provides analytics in understanding and improving the accuracy of diagnosis coding and Star Performance. In collaboration with other business areas, this position assists in problem solving, solution development and strategic planning and decision making. Accountable for complying with all laws and regulations associated with duties and responsibilities.

• Performs scientific and technical planning, analysis, reporting and methodological support to measure and improve medical diagnosis coding and documentation.
• Supports leadership in reporting to assist in the planning, implementation, and measurement of coding accuracy/RADV/Stars processes.
• Performs analytics and provides insights on Medicare Advantage STARs and coding accuracy.
• Provides ongoing data analysis and recommends focus and direction of resources for decision makers and management that is relevant to the healthcare market; assists in problem solving, solution development, decision making, and strategic planning.
• Hypothesizes and develops attributes that characterize or predict coding accuracy and Star Performance.
• Leverages reporting software and models to develop attributes on population(s) and identifies opportunities to close gaps.
• Performs peer data quality reviews, validating data and processes to ensure accuracy, completeness, and consistency of department output; recommends process improvements as necessary. Investigate existing national and regional data and perform descriptive and analytic studies using basic analytical/statistical techniques.
• Serves as technical expert advisor to collaborating departments on corporate and cross-functional projects, reports, and activities.

Specific Responsibilities

• Collaborate with leadership to manage Risk Adjustment initiatives to improve coding accuracy & efficiency.
• Analyze & prioritize suspected conditions to guide allocation of resources for Retrospective Review projects.
• Facilitate necessary data elements required for chart chase projects.
• Identify trends & high fail conditions in the RADV audit submission to improve diagnosis coding accuracy.
• Quantify the impact of interventions to evaluate the efficacy of existing programs.
• Provide necessary analytic & data requirements to facilitate pilot programs, collaboration with vendors, and departmental projects.

Skills and Abilities

• Requires experience building predictive models.
• Strong knowledge of outcome research design and controlled study design is preferred.
• Advanced knowledge of SAS including Enterprise Miner is preferred.
• R, Python, Tableau
• Basic knowledge of United States healthcare delivery system in payer setting or provider
• setting is required.