Remote Lead Actuarial Consultant - Risk Adjustment

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Requirements:

• Bachelor’s degree required in Math, Statistics, Economics, Actuarial Science, or a related field.
• 8+ years of actuarial experience with 5+ years working within healthcare.
• 3+ years working with a CMS/HHS HCC risk adjustment modeling is required.
• 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred.
• 2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred.
• Working knowledge of the CMMI Direct Contracting or ACO program.
• Experience leading projects and ownership of deliverables.

Responsibilities:

• Build, maintain, and own the CMS HCC risk scoring model.
• Lead quarterly risk adjustment analysis and forecasting.
• Document and present summary review memos for quarterly analysis.
• Evaluate financial implications of provider participation in networks.
• Lead provider risk contract evaluations and performance evaluations.
• Collaborate with Operations Risk Adjustment team on forecasting models.
• Perform ad-hoc data analysis using Excel, SAS, SQL.