Job description
We have an opportunity to join the Alliance as a Senior Risk Adjustment Data Analyst in the Risk Adjustment Department.
WHAT YOU’LL BE RESPONSIBLE FOR
Reporting to the Risk Adjustment Director, this position will perform complex analytical data mining and reporting in support of the Risk Adjustment Department. You will also lead initiatives, provide program support, and perform project management related to data gathering and analysis as well as act as a subject matter expert and resource regarding risk adjustment data.
ABOUT THE TEAM
Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members’ health outcomes, support the success of our provider partners, and ensure regulatory alignment.
THE IDEAL CANDIDATE
- Well versed in risk adjustment methodologies, particularly within the Medicare space
- Familiarity with risk adjustment models and their impact on plan performance and payment
- Proficiency in SQL, and an ability to analyze and translate complex healthcare data into meaningful and actionable insights, in addition to general reporting
- Experience with data visualization tools to present insights clearly and effectively
- Self-directed and proactive, with the ability to manage priorities and drive projects forward
- Strong collaborator who can work effectively with organizational teams, including IT, finance, operations, clinical and compliance teams
- Medicaid/Medi-Cal experience a plus
WHAT YOU’LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here.
Knowledge of:
- Quantitative data analysis methodologies and analytical tools related to risk adjustment reporting and analysis
- Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
- Medicare program and related regulations
- Medicare (Hierarchical Condition Categories) risk adjustment models
- Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations
Ability to:
- Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations
- Perform technical and non-technical troubleshooting and diagnose and resolve complex problems, including problems that may have multiple variables and may not have obvious solutions
- Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
- Work collaboratively and productively with diverse project teams in order to achieve efficient and timely solutions
Education and Experience:
- Bachelor’s degree in Finance, Business, Information Technology, or a related field
- A minimum of five years of experience performing health care finance reporting and analytics, including a minimum of three years of experience working in a Medicare environment (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.
OTHER INFORMATION
- We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
- While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
- In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate’s qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area
Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area
Zone 1 (Monterey, San Benito and Santa Cruz)
$96,979—$155,168 USD
Zone 2 (Mariposa and Merced)
$88,251—$141,211 USD
OUR BENEFITS
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
- And many more
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
