Sr Manager, Risk Adjustment Analytics

Job summary

We are seeking a Senior Manager to join our Integrated Kidney Care (IKC) Revenue Analytics team, which is responsible for all CMS risk adjustment-related analytics. This role will lead the financial and strategic aspects of risk adjustment, providing actionable insights that inform executive-level decision-making. The ideal candidate will have a strong background in analytics, finance, and risk adjustment, with the ability to translate complex data into strategic recommendations. This is an exciting opportunity to shape the direction of risk adjustment analytics within a dynamic and growing organization.

Essential responsibilities:

• 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 years 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

What Well Provide:

More than just pay, our Rewards package connects teammates to what matters most. Teammates are eligible to begin receiving benefits on the first day of the month following or coinciding with one month of continuous employment. Below are some of our benefit offerings.

• Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out
• Support for you and your family: Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more

• Professional development programs: Offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through an online training platform.

Originally posted on Himalayas