- Analyze Medicare Advantage and ACA Risk Adjustment program performance to identify opportunities for RAF improvement and revenue optimization.
- Provide expertise on CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry best practices.
- Evaluate operational and financial performance metrics and develop data-driven recommendations.
- Support client-facing initiatives, business reviews, and executive presentations.
- Analyze, cleanse, transform, reconcile, and validate healthcare datasets from multiple sources.
- Perform analysis across Claims, Encounters, Eligibility, Pharmacy, Medical Record Review, and Health Assessment datasets.
- Conduct root cause analysis and recommend corrective actions to improve data integrity and operational performance.
- Manage CMS data sources, support reconciliation and forecasting, and develop reports, scorecards, ad hoc analyses, and executive dashboards.
- Develop, optimize, and troubleshoot SQL queries, stored procedures, and data extraction processes.
- Collaborate with business, operations, technology, and analytics teams on scalable solutions, automation, and process improvement.
SQLMicrosoft SQL Server