Resp & Qualifications
Supports Risk Adjustment & Stars organization to optimize Risk Adjustment revenue and coding accuracy through data-driven approach to closing gaps and risks in coding and care delivery across Medicare & Medicaid populations. Responsible for developing performance monitoring reports and analytics related to Risk Adjustment & Stars programs and processes.
Develops and works with structured data from multiple sources such as HEDIS, CAHPS, Stars and Risk Adjustment related performance and benchmark data. Interprets data, analyzes results using statistical techniques, and provides ongoing reports.
Designs, manages, and conducts review of Risk Adjustment & Stars program data sets using data from multiple systems. Produces regular and adhoc report for business stakeholders to monitor and track Risk Adjustment and Stars performance metrics and enable Risk Adjustment optimization.
Uses business intelligence, statistical, and/or data science techniques to analyze data to evaluate the efficacy of Risk Adjustment & Stars activities (HEDIS, CAHPS, Health Outcomes Survey, Operation & Accurate Risk Optimization initiatives).
Collaborates with third party vendors and internal stakeholders including Stars/Quality, Finance and Actuarial areas to optimize Risk Adjustment performance, accurate coding and drive overall quality of care.
Establishes standards with IT and Data Services teams. Represents the Stars/Risk Adjustment team during enterprise prioritization sessions.
Education Level: Bachelor's Degree
Education Details: Data Science, Mathematics, Computer Science, Statistics, Business or related field
Experience: 5 years experience in Risk Adjustment/Quality/Stars departments with a data visualization and performance monitoring role
Knowledge, Skills and Abilities (KSAs):
Strong Risk Adjustment & Stars knowledge.
Strong quantitative and qualitative skills.
Knowledge and understanding of analytical & data visualization tools, such as Power BI, SAS, Excel, SQL.
Excellent communication skills both written and verbal
Ability to learn quickly and take direction.
Department: MD Medicaid- Medicare, Quality
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 6/3/21
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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