Lead Analyst, National Risk Adjustment Predictive Analytics
New
J
JobgetherHealthcare Analytics
United StatesFull-TimeLead
Salary72,370.82 - 156,803.45 USD per year
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Job Details
- Experience
- Minimum of 4 years of experience developing complex SQL queries, functions, procedures, and data designs within relational database environments.
- Required Skills
- AWSSQLMicrosoft Power BIAzure
Requirements
- Minimum of 4 years of experience developing complex SQL queries, functions, procedures, and data designs within relational database environments.
- Hands-on experience with Microsoft T-SQL, Databricks SQL, Power BI, SQL Server Integration Services (SSIS), and SQL Server Reporting Services (SSRS).
- Experience applying predictive modeling, statistical analysis, forecasting, and performance tracking techniques within healthcare, quality, HEDIS, risk adjustment, finance, or health plan environments.
- Demonstrated ability to work with complex datasets and quantify financial, utilization, operational, and performance metrics.
- Experience with cloud or distributed data platforms such as Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
- Strong analytical thinking, attention to detail, problem-solving ability, and experience performing structured root-cause analysis.
- Strong business acumen with the ability to connect analytical findings to broader strategic and operational objectives.
- Proven ability to lead cross-functional initiatives and deliver measurable results within highly matrixed organizations.
- Ability to manage multiple priorities and meet demanding deadlines in a fast-paced, agile environment.
- Proficiency with Microsoft Office applications.
- Familiarity with Python and R programming or broader data science techniques is preferred.
Responsibilities
- Lead analytical support for prospective and retrospective risk adjustment intervention strategies, including tracking progress, outcomes, and financial or operational impact.
- Design and develop systems to track risk scores, intervention outcomes, market performance, and results across multiple lines of business.
- Develop automated and ad-hoc quality assurance reporting modules supporting Medicaid, Marketplace, Medicare, and Medicare-Medicaid programs.
- Support the development of automated suspect, targeting, and ranking engines to identify opportunities for risk adjustment interventions.
- Analyze complex healthcare datasets using data mining, validation, scrubbing, and root-cause analysis techniques.
- Identify anomalies, outliers, changing trends, and improvement opportunities using statistical methodologies, and translate findings into executive-level recommendations.
- Apply extrapolation, interpolation, forecasting, and other analytical techniques to predict trends in cost, utilization, risk scores, and performance.
- Partner with cross-functional stakeholders and leaders to define business requirements, clarify data needs, and communicate findings.
- Manage changes and upgrades to data warehouse and analytics environments while maintaining continuity.
- Monitor CMS and state risk adjustment regulations and incorporate changes into analytical activities.
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